Limb deficiency Flashcards
What is the most common cause of limb deficiency
60% congenital
Limb buds appear in the ________ week of embryonic development and are completed by the _____ week
4th week 7th week
What are the two philosophies for UE deficiencies
Sit to fit vs task specific
Children who wear 2-4 prostheses may not have _________________
enough exposed skin to disperse heat adequately
note: also since child has less limbs the have less total surface of skin to disperse heat
A Aitken classification of PFFD (proximal femoral focal deficiency)
acetabulum present
femoral head present
shorter femur
B Aitken classification of PFFD (proximal femoral focal deficiency)
well defined acetabulum
unossified femoral head
C Aitken classification of PFFD (proximal femoral focal deficiency)
no femoral head
poorly defined acetabulum
D Aitken classification of PFFD (proximal femoral focal deficiency)
extremely short or absent femur (no acetabulum)
What are the surgical and non-surgical options for PFFD (Proximal femoral focal deficiency)
Lengthening of femur (if hip and knee are stable)
Boyd/symes amputation
Van Nes Rotation Osteotomy
Knee fusion
Epiphysiodesis to create shorter residual limb for prosthesis (need femur to be 5cm shorter than contralateral sie)
No surgery, with use of extension prothesis
Child has no acetabulum and severely shortened femur
Aitken D
Child has well defined acetabulum but unossified femoral head
Aitken B
What is the most common gait deviation with PFFD?
Posterior and lateral trunk lean during stance phase due to poor strength of abductors and extensors
What are the clinical findings of PFFD
Hip instability
Malrotation
Insufficient proximal mm
Limb length deficiency
Limb usually in flexion abd er
70-80% have fibula deficiency
What are the 3 types of tibial deficiencies
- Complete absence of tibia, no quads
- Proximal tibia well formed, quadriceps present
- Presence of distal tibia only
How do tibial deficiencies present
Abnormal articulation of knee and ankle
Equinovarus foot deformity
Leg length discrepancy
Tibial deficiencies also come with what problems
No ACL
Anterior bowing
Varus/valgus deformities
Revisions needed during growth
Missing 1st or 2nd rays
For tibial deficiencies it is crucial to _____
Check for sufficient quadriceps to drive amputation level
What surgery do children get if tibia is absence
Knee disarticulation
(Removal of any bones below knee and attaching the foot to the femur)
What are the 2 classifications of fibular hemimelia
Type 1: hypoplastic fibula
Type 2: absent fibula
How will fibular hemimelia present
May be missing lateral toes
Anterior medial bowing common with dimple
May have short femur
ACL deficiency or absent
Varus or valgus deformities as they grow
Missing lateral 2 or 3 ray of foot
What surgeries will a child with fibular hemimelia get
Boyd - removal of foot but keep the calcaneus for WB surface
Or
Symes - removal of entire foot
A child using a prosthetic might need what for the other foot
Shoe lifts
At what age can you provide a prosthetic for a congenital deficiency
Once a child can pull to stand (8-12 month)
Why is stump wrapping preformed prior to prosthetic use
If not preformed, the residual limb will shrink once ambulation begins and they will not fit in the socket anymore
How should you teach a child to desensitize their amputation site
“Love on your leg/arm”
Use massage of different pressures
Different temps
Different textures
You require atleast _____ of hip ext for terminal stance stride
5-10
T or F: patients need to stretch up until they get their prosthetic
F, they need to continue stretching even after they get their prosthetic
Pt needs full knee ext for ____
And neutral adduction in order to ____
Stance stability
In order to get prosthesis under body for normal BOS
What should patients with BKA (below knee amputation) avoid
Putting pillow under knee
Sitting in wheelchair with knee always flexed
Pts with traumatic injuries with a
AKA (above knee amputation) are at risk for ______ contractures
We should encourage sleeping ____
Hip flexion, ER, abduction contracture
Encourage sleeping prone
What is the overall progression for gait training w a prosthetic
Stance -> stride -> stepping
What treatments can we use to target weight shifting and control in SLS
moving tennis ball under foot
Step ups (maybe with targets?)
What kind of facilitation works best for gait training younger children who can’t follow instructions
PNF
Will children plateau in PT?
Only if you’re not challenging them enough
Children should never plateau
Boys are _____ as likely as girls to suffer a TBI
Twice
What are the 3 most common causes of infant TBI
Falls
Near drowning
Abuse
Why will physicians opt to diagnose children with CP even if they’re not a classical case of CP
Because it will allow the children to have more benefits from insurance
Kids under _____ years that have an insult to the brain can be diagnosed with CP
Under 3
How well do children recover from concussion
20% in 24 hours
64% in 1-7 days
11% in 1-4weeks
2% in greater than 1 month
Children r more vulnerable to concussions/TBI
Not a question, just know it!
What secondary impairment might follow a TBI
5-20% of children who sustain a TBI will develop heterotopic ossification
The prognosis for acquiring new skills is _____ the younger the child has a TBI
Worse
Consideration of ____ Is key for successful intervention in TBIs
Rancho level
For children with rancho 1-3 what do we do?
Maintain ROM, skin integrity
Provide sensory stimuli
How can we set up an activity to break up tone
Set up the activity that makes it impossible for them to go into those positions
If a child has extension tone where do we need their toy to be to help break up tone
In front of them where they must bend over to encourage flexion and avoid extension
______ is key, as well as therapist demonstration, when a patient is unable to follow commands
Toy/activity placement
For rancho 4-6, what are our priorities
Provide structure and prevent overstimulation
Engage in task specific training
Emphasize safety
Relaxation techniques
Encourage mobility
Work on attention to task
For rancho 7-10 what are our goals
Allow for increase independence
safe community reintegration
____ is key for SCI patients
Education and family being on board
They can regress quickly if they aren’t following HEP
During tasks do we want a large or narrow BOS
Narrow
It’s better for muscle activation
When working with patients, how many impairments do we want to address with each treatment
As many as possible!!
When would we want to do part-task practice
If a pt is extremely limited with one specific part of a task and it’s significantly slowing down their progress on other aspects
What’s the difference between traditional therapy and Activity Based Restorative therapy ABRT
ABRT activated the NS above and BELOW level of lesion
Higher intensity
Includes patterned movements
Restores lost function instead of compensates
Minimizes compensatory devices
Where do we want to apply facilitation to a patient
At the point of failure (the weakest muscles)
Whether it be quads, glutes, anterior tib, or trunk
