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Practice Topics Exam 4 > LE Prosthetics - 2 - Assessment > Flashcards

LE Prosthetics - 2 - Assessment Flashcards

1
Q

Functional testing

A

Prosthetist can’t do it to get reimbursed, so they have to have someone else do it
PTs!

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2
Q

How do we do functional testing

A

Amputee mobility predictor!

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3
Q

Amputee mobility predictor - what is it

A

21 tests for assessing particular level of function in a patient
made by Gailey

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4
Q

Amputee mobility predictor! - what does it take

A

Simple equipment

Stopwatch, 12 inch ruler, 4 in box, 2 chairs

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5
Q

Amputee mobility predictor - scoring

A

K levels

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6
Q

Amputee mobility predictor! - K0

A

Regardless of prosthesis you give them, they will not walk

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7
Q

Amputee mobility predictor - K1

A

transfer prosthesis

value of it - safety - could be the difference that allows them to be more independent and allow them to be home

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8
Q

Amputee mobility predictor! K2

A

Single speed ambulator
So no matter what, is always going the same speed
Can usually only traverse low level barriers in community

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9
Q

Amputee mobility predictor! K3

A 
Multispeed ambulator (they can change their speed)
No barriers - unlimited community ambulator
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10
Q

Amputee mobility predictor! K4

A

High activity like sports

Other than peds, most of us do not function at K4 level

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11
Q

Expectations

A

Setting expectations
Know what each participant expects - need to understand what they want to do with their prosthesis
What are they motivated to accomplish

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12
Q

K1 what kind of knee

A

Manual locking

Gives stability

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13
Q

K2 - what kind of knee

A

Manual locking
Weight activated control
Pneumatic knee systems
Polycentric4 or 7 Bar linkage systems

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14
Q

K3 and K4 - what kind of knee

A

Polycentric4 or 7 Bar linkage systems

Hydraulic control

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15
Q

3 views of prosthetic gait - planes

A

Sagittal is the most common that prosthetists talk about

Frontal would be next (looking at varus/valgus forces)

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16
Q

CAUSE

A 
Component
Alignment
User
Socket
Education
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17
Q

CAUSE - component

A

any piece of the hardware that is causing the issue

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18
Q

CAUSE - alignment

A

something off with the alignment - maybe too much rotation

When they measure alignment, the manufacturer tells them where the alignment should go

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19
Q

CAUSE - User

A

maybe they have something to cause the dysfunction (maybe tight hip ER)

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20
Q

CAUSE - socket

A

if socket does not fit properly

Varicose hyperplasia - pt not making contact distally so get suction - cancer risk!

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21
Q

CAUSE - education

A

person wearing it
PT
prosthetist

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22
Q

The challenge - cluitmans

A

Any prosthesis necessitates a good suspension in swing phase and adequate pressure distribution in the stance phase

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23
Q

The challenge - johannesson

A

Amputees are exposed to a high degree of load at all times

Difference is that the structures (skin) that are exposed to the loads are not originally intended for this purpose

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24
Q

Diabetic skin tissue overview - Distal end blistering

A

usually caused by void or space in distal aspect

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25
Q

Diabetic skin tissue overview - Irritation following removal

A

mineral build up

could be related to perspiration - crystalize and cause itchiness

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26
Q

Intersurface selection - residual limb length - suspension option - SHORT

A 
Upper 1/3
Locking suspension
  - Volume instability 
  - Security
Cushion/sleeve
  - Simplicity
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27
Q

Intersurface selection - residual limb length - suspension option - MEDIUM

A 
middle 1/3
Locking suspension 
  - Volume instability 
  - Security
Seal in suspension
   - ease of use and ROM
   - low build height
Cushion/sleeve
  - Simplicity
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28
Q

Iceross liner selection - the issue

A 
Poor suspension
Inc shear
Inc peak pressure
Discomfort
Tissue damage
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29
Q

Iceross liner selection - the soluation

A 
Rolling it on (invert it first)
Reduce pistoning
Absorb shear
Dissipate peak pressure
Protect skin envelope
Stabilize soft tissue
30
Q

Shore value/Durometer is what

A

Measure of hardness

31
Q

Iceross liner durometer/design

A 
Dermo
Comfort
Synergy
Sport
Transfemoral
Original
32
Q

Iceross liner durometer/design - comfort is

A

30

33
Q

Iceross liner durometer/design - dermo

A

25 (softest)

34
Q

Iceross liner durometer/design - synergy

A

40/25
soft on inside, hard on outside
good for active person

35
Q

Iceross liner durometer/design - sport

A

get more proprioception and feedback from it

50/25

36
Q

Iceross liner durometer/design - transfemoral

A

High durometer
50
we have a lot of soft tissue so don’t need as much padding

37
Q

Iceross liner durometer/design - original

A

60

38
Q

Iceross liner durometer/design - indicated for diabetic amputees

A

Synergy (40/25)
Comfort (30)
Dermo (25)

39
Q

Iceross liner selection - thickness

A

3 MM

6 MM

40
Q

Iceross liner selection - thickness - 3 MM

A 
Distal protection
Tapered to grade pressure
Thin around knee
Reduced pressure on thigh
Designed for protection and performance
41
Q

Iceross liner selection - thickness - 6 MM

A

Distal protection
Enhanced proximal protection
Designed for ultimate tissue protection

42
Q

Iceross liner selection - sizing technique

A

Measure 4cm from distal end
Measure circumference
Select Iceross as measured (if btw sizes, downsize with seal in liner)

43
Q

Iceross liner selection - suspension options

A

Locking
Cushion (use sleeve on outside)
Seal in (leave on inside of socket)

44
Q

Iceross liner selection - Suspension options: Locking

A

Matrix - prevents tissue stretching
Size specific umbrella to prevent compression
Overall prevents movement up and down btw the prosthesis

45
Q

Socket design - total surface bearing- describe

A 
Vlume match (residual limb to socket)
Distribution of load over max area
Control of soft tissue position
Minimize pressure peaks
Minimal movement of bone/socket
Forces normal to surface (less shear)
Optimized with pressure casting
46
Q

Socket design - total surface bearing - axial/dynamic forces

A

Socket shaping
Pre-compression of soft tissue
Adaptation of liner thickness

47
Q

Socket design - total surface bearing- rotational forces

A

Shear absorbed by the liner

Contact area with socket wall

48
Q

Socket design issues

A

Reliefs and air pockets

Posterior wall trimmed too low

49
Q

Volume related issues

A

Undersized (M/L instability)
Even/Correct
Oversized (fibula head and distal tibial pressure)

50
Q

CadCam imaging

A

Computerized image of residual limb
Modifications and socket adjustments made on computer
Digital image created and stored in database
Data transferred to produce exact socket

51
Q

Prosthetic feet - recommendation

A

prescribed according to activities the pt has the potential to achieve

52
Q

Prosthetic foot serves the purose of

A

connecting the prosthesis to the ground

53
Q

Classification of prosthetic foot - single axis

A 
Foot with a hinge to it
Allows PF and DF
Rapid foot flat
Provides knee stability
Primarily rx for transfemoral amputees
54
Q

Classification of prosthetic foot - multiple axis

A

Allows foot to accommodate terrain

Inv/ev

55
Q

Classification of prosthetic foot - SACH

A 
Solid ankle cushioned heel
Low maitenence
Low cost
Adjusted heel heigh
The ultimate in durabiity
56
Q

Classification of prosthetic foot - Elastic keel

A

allows for compliance

57
Q

Classification of prosthetic foot - Dynamic response

A

Energy storage at heel strike
Spring in heel compresses and as they come foward it will decrompress and help with push off
Energy storage in loading response

58
Q

Bench alignment - sagittal plane

A

Sagittal plane
Socket flex 5-10 deg
Mark ntersection of post and middle third of foot
Alignment reference line should fall at junction of the posterior and middle third of the foot length

59
Q

Bench alignment - coronal plane

A

Coronal plane
Socket add 5 degrees
Bisect socket

60
Q

Static alignment

A

knee in neutral flex/ext
full WB
Assess coronal balance
pelvic stability

61
Q

Shoes

A

Consider stability, safety of remaining foot, don and doff, consistent heel height, cosmesis
Make sure same heel to toe ratio for shoes worn

62
Q

Dynamic alignment checklist

A 
Height level
Smooth trans to stance
Swing smooth
Proper heel/toe lever
Proper stiffness in heel 
Limited shift in socket
Vertical pylon
Body symm
Arm swing
63
Q

Transfemoral levels

A

Knee disarticulation - adductors still intact, long residual limb BUT knee center lower than other side
Long AK - still long residual but now 70% of add gone so less stability
Short AK - still functional but see a lot of Trend
Hip disarticulation - works like bench so can still be functional (usually CA)
Hemipelvectomy (Not functional, usually CA)

64
Q

Transfemoral - Preparation for fitting

A 
Wrapping limb
Distal to proximal
No gaps
Above the hip
Requires multiple applications
Shrinker socks
65
Q

Socket design - transfemoral

A

Quad

Narrow medial lateral (ischial containment)

66
Q

Socket design - transfemoral - ischial component

A

Comes up on medial side of ischial tub creating a bony lock

Typically less comfortable

67
Q

Socket design - transfemoral - quadrilateral

A

they sit on ischial tub like sitting on bench

68
Q

Transfemoral - Bench alignment

A

Socket rotation
External foot rotation
TKA - Trochanter knee ankle
Tend to have more flexion contractures

69
Q

Transfemoral - Bench alignment - TKA

A

Trochanter knee ankle
Stationary alignment line to identify relative alignment between the center of the socket weight line, the rotation point of the knee and the functional rotation point of the ankle/foot

70
Q

Transfemoral - Static alignment

A

Stationary alignment to establish:

  • height
  • foot rotation
  • socket position: flexion/ext, ad/abd, AP position, ML position
71
Q

Transfemoral - Dynamic alignment

A

Allows for minute adjustments to the prosthesis
Customizes alignment of prosthesis to the pt needs
Ensures max activity and stability resulting in achieving the highest possible outcome

72
Q

Transfemoral - Alignment - purpose

A

The goal is to align the prosthesis so that the amputee uses the minimum amount of alignment stability or involuntary knee control necessary to optimize voluntary control
Critical balance between mobility and stability to a achieve a safe and efficient gait

Practice Topics Exam 4 (9 decks)

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