Limb deficiency Flashcards

1
Q

What is the most common cause of limb deficiency

A

60% congenital

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2
Q

Limb buds appear in the ________ week of embryonic development and are completed by the _____ week

A

5th week 7th week

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3
Q

What are the two philosophies for UE deficiencies

A

Sit to fit vs task specific

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4
Q

Children who wear 2-4 prostheses may not have _________________

A

enough exposed skin to disperse head adequately

note: also since child has less limbs the have less total surface of skin to disperse heat

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5
Q

A Aitken classification of PFFD (proximal femoral focal deficiency)

A

acetabulum present

femoral head present

shorter femur

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6
Q

B Aitken classification of PFFD (proximal femoral focal deficiency)

A

well defined acetabulum

unossified femoral head

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7
Q

C Aitken classification of PFFD (proximal femoral focal deficiency)

A

no femoral head

poorly defined acetabulum

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8
Q

D Aitken classification of PFFD (proximal femoral focal deficiency)

A

extremely short or abscent femur (no acetabulum)

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9
Q

What are the surgical options for PFFD (Proximal femoral focal deficiency)

A

Lengthening of femur (if hip and knee are stable)

Boyd/symes amputation

Van Nes Rotation Osteotomy

Kne 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

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10
Q

Child has no acetabulum and severely shortened femur

A

Aitken D

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11
Q

Child has well defined acetabulum but unossified femoral head

A

Aitken B

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12
Q

What is the most common gait deviation with PFFD?

A

Posterior and lateral trunk lean during stance phase due to poor strength of abductors and extensors

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13
Q

What are the clinical findings of PFFD

A

Hip instability

Malrotation

Insufficient proximal mm

Limb length deficiency

Limb usually in flexion abd er

70-80% have fibula deficiency

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14
Q

What are the 3 types of tibial deficiencies

A
  1. Complete absence of tibia, no quads
  2. Proximal tibia well formed, quadriceps present
  3. Presence of distal tibia only
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15
Q

How do tibial deficiencies present

A

Normal articulation of knee and ankle

Equinovarus foot deformity

Leg length discrepancy

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16
Q

Tibial deficiencies also come with what problems

A

No ACL

Anterior bowing

Varus/valgus deformities

Revisions needed during growth

Missing 1st or 2nd rays

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17
Q

For tibial deficiencies it is crucial to _____

A

Check for sufficient quadriceps to drive amputation level

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18
Q

What surgery do children get if tibia is absence

A

Knee disarticulation

(Removal of any bones below knee and attaching the foot to the femur)

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19
Q
A
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20
Q

What are the 2 classifications of fibular hemimelia

A

Type 1: hypoplastic fibula

Type 2: absent fibula

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21
Q

How will fibular hemimelia present

A

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

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22
Q

What surgeries will a child with fibular hemimelia get

A

Boyd - removal of foot

Or

Symes - removal of foot but keep the calcaneus for a WB surface

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23
Q

A child using a prosthetic might need what for the other foot

A

Shoe lifts

24
Q

At what age can you provide a prosthetic for a congenital deficiency

A

One a child can pull to stand (8-12 month)

25
Q

Why is stump wrapping preformed prior to prosthetic use

A

If not preformed, the residual limb will shrink once ambulation begins and they will not fit in the socket anymore

26
Q

How should you teach a child to desensitize their amputation site

A

“Love on your leg/arm”

Use massage of different pressures

Different temps

Different textures

27
Q

You require atleast _____ of hip ext for terminal stance stride

28
Q

T or F: patients need to stretch up until they get their prosthetic

A

F, they need to continue stretching even after they get their prosthetic

29
Q

Pt needs full knee ext for ____

And neutral adduction in order to ____

A

Stance stability

In order to get prosthesis under body for normal BOS

30
Q

What should patients with BKA (below knee amputation) avoid

A

Putting pillow under knee

Sitting in wheelchair with knee always flexed

31
Q

Pts with traumatic injuries are at risk for ______ contractures

We should encourage sleeping ____

A

Hip flexion, ER, abduction contracture

Encourage sleeping prone

32
Q

What is the overall progression for gait training w a prosthetic

A

Stance -> stride -> stepping

33
Q

What treatments can we use to target weight shifting and control in SLS

A

moving tennis ball under foot

Step ups (maybe with targets?)

34
Q

What kind of facilitation works best for gait training younger children who can’t follow instructions

35
Q

Will children plateau in PT?

A

Only if you’re not challenging them enough

Children should never plateau

36
Q

Boys are _____ as likely as girls to suffer a TBI

37
Q

What are the 3 most common causes of infant TBI

A

Falls

Near drowning

Abuse

38
Q

Why will physicians opt to diagnose children with CP even if they’re not a classical case of CP

A

Because it will allow the children to have more benefits from insurance

39
Q

Kids under _____ years that have an insult to the brain can be diagnosed with CP

40
Q

How well do children recover from concussion

A

20% in 24 hours

64% in 1-7 days

11% in 1-4weeks

2% in greater than 1 month

41
Q

Children r more vulnerable to concussions/TBI

A

Not a question, just know it!

42
Q

What secondary impairment might follow a TBI

A

5-20% of children who sustain a TBI will develop heterotopic ossification

43
Q

The prognosis for acquiring new skills is _____ the younger the child has a TBI

44
Q

Consideration of ____ Is key for successful intervention in TBIs

A

Rancho level

45
Q

For children with rancho 1-3 what do we do?

A

Maintain ROM, skin integrity

Provide sensory stimuli

46
Q

How can we set up an activity to break up tone

A

Set up the activity that makes it impossible for them to go into those positions

47
Q

If a child has extension tone where do we need their toy to be to help break up tone

A

In front of them where they must bend over to encourage flexion and avoid extension

48
Q

______ is key, as well as therapist demonstration, when a patient is unable to follow commands

A

Toy/activity placement

49
Q

For rancho 4-6, what are our priorities

A

Provide structure and prevent overstimulation

Engage in task specific training

Emphasize safety

Relaxation techniques

Encourage mobility

Work on attention to task

50
Q

For rancho 7-10 what are our goals

A

Allow for increase independence when

safe community reintegration

51
Q

____ is key for SCI patients

A

Education and family being on board

They can regress quickly if they aren’t following HEP

53
Q

During tasks do we want a large or narrow BOS

A

Narrow

It’s better for muscle activation

54
Q

When working with patients, how many impairments do we want to address with each treatment

A

As many as possible!!

55
Q

When would we want to do part-task practice

A

If a pt is extremely limited with one specific part of a task and it’s significantly slowing down their progress on other aspects

56
Q

What’s the difference between traditional therapy and Activity Based Restorative therapy ABRT

A

ABRT activated the NS above and BELOW level of lesion

Higher intensity

Includes patterned movements

Restores lost function instead of compensates

Minimizes compensatory devices

57
Q

Where do we want to apply facilitation to a patient

A

At the point of failure (the weakest muscles)

Whether it be quads, glutes, anterior tib, or trunk