Neuro- Final Flashcards by Erin Harting

More than _ _ Americans of all ages and both genders genders have amputations. Approximately _ individuals each year in the US.

1.5 million Americans have amputations

Approx. 156,000/ year

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Prevalence: More _ than _ are affected. More common in _ than _. Prevalence increases with _.

More MEN than WOMEN

More common in BLACKS than WHITES

Prevalence increases with AGE

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Diabetes: US is _ in the world for number of individuals with diabetes. Diabetic men have a _ _ risk of amputation. Women?

US is 3RD in the world for number of individuals with diabetes

Diabetic men have a 10X HIGHER RISK
Diabetic women have a 14X HIGHER RISK. . . Of amputation

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2 types of vascular disease that can lead to LE amputation

Chronic venous insufficiency
Arteriosclerosis

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MVA, farming accidents, firearms, fireworks, electrical burns, power tool accidents are all examples of?

Trauma that can lead to LE amputation

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_ _ in a limb might require LE amputation. What is the most common type? Peak occurrence?

NEOPLASTIC DISEASE in a limb . . .

BONY SARCOMA is the most common type with peak occurrence 10-25 (slightly more common in men)

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_ is a common complication of peripheral vascular disease, diabetes, or can be acquired in a hospital setting, which can lead to LE amputation

OSTEOMYELITIS is common complication . . .

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_ _ (_) and _ _ (commonly seen with _ _) are both common infections that can lead to LE amputation.

SUPER BUGS (MRSA) and NECROTIZING FASCIITIS (commonly seen with E COLLI) are both common infections that . . .

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Surgical goals: remove _ _; construct a __ that will allow attachment of a _ or _ _ part. The _ the amputated limb; the _ _ the outcome.

Remove DISEASED TISSUE; construct a RESIDUAL LIMB that will allow attachment of a PROSTHESIS or ARTIFICIAL REPLACEMENT part.

The SHORTER the amputated limb; the LESS SATISFACTORY the outcome

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Residual limb length determines: _ control; _ _ retained; total _ _; degree of _ _; number of _ _ required; _ of and _ of prosthetic limb; and possibly _ _ loss (will vary depending upon patient).

LEVER control; MUSCLE MASS retained; total SURFACE AREA; degree of BALANCE DISTURBANCE; number of MECHANICAL JOINTS required; WEIGHT of and COMPLEXITY of prosthetic limb; and possibly CONTRALATERAL WEIGHT loss (will vary depending upon patient)

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What is the biggest complication of amputation? Percentage? If it occurs it may require _ of _ and a _ _ at a _ _.

Infection is the biggest complication- 15%

IF it occurs it may require REMOVAL of PROSTHESIS and a SECOND AMPUTATION at a HIGHER LEVEL

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_ is caused by abrasion or compression by improper fit of dressing or prosthesis and/ or excessive weight bearing. What is the best way to prevent?

ULCERATION is caused by abrasion . . .

SKIN INSPECTIONS are the best way to prevent

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Failure of the ‘stump’ to heal can be due to _ _ supply, _, other _, or _. What type of therapy can help with revascularization?

Can be due to: INADEQUATE BLOOD supply, INFECTION, other DISEASE, or SMOKING.

LEECH THERAPY can help with revascularization

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_ _ _ is a complication of amputation that can be either _ or _.

RESIDUAL LIMB PAIN is a complication of amputation that can be either INTRINSIC OR EXTRINSIC

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_ _ are defined as a painless awareness of the amputated part.

PHANTOM SENSATION

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_ _ is defined as a painful and disagreeable sensation experienced below the residual limb. _% of amputees experience _ _ _.

PHANTOM PAIN is defined as a painful . . .

80% o amputees experience PHANTOM LIMB PAIN

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Touch, pressure, cold, wetness, itching, movement are all examples of?

Phantom sensations

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Dull aching, burning, stabbing, electrical shock, unnatural positioning and leg being pulled off are all examples of?

Commonly felt types of phantom pain

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The treatment for Phantom pain/ sensation will _ depending on the _.

Will VARY depending on the PATIENT (what works varies)

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Examples of treatments for phantom pain/ sensation: _ wrap or _ sock; _ the stump; wrap in _ _ or _ ; _ the _ _ ( then slowly _ _); _ or _; _ relaxation

EXAMPLES:

ACE wrap or SHRINKER sock
MASSAGE the stump
wrap in HEATING PAD OR SOFT FABRIC
EXERCISE the RESIDUAL LIMB (TIGHTEN then slowly RELAX MUSCLES)
TENS or ULTRASOUND
MENTAL relaxation

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Treatment for phantom pain/ sensation: _ stump with _ _; CNS _ _ (nerve _); _; electric _; sensory _; _ intervention; _; _ therapy (helps _ understand _ _ _)

POUNDING stump with WOODEN MALLET
CNS DESTRUCTIVE PROCEDURES (nerve ABLATION)
ACUPUNCTURE
Electric SHOCK
PSYCHOLOGICAL intervention
BIOFEEDBACK
MIRROR therapy (helps BRAIN understand WHAT IS HAPPENING)

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A _ _ _ is a psychological issue that is manifesting as a physical issue.

A SOMATOFORM DISORDER is a . . .

Possible causes of _ include muscle imbalance or fascial tightness, protective withdrawal reflex, loss of plantar stimulation in extension or faulty positioning.

Possible cause of CONTRACTURES include muscle imbalance . . .

Contractures affect a patients _ for _, fit of _, and _ _. Also increases potential for _ _.

Affect patients CANDIDACY for PROSTHESIS, fit of PROSTHESES, and FUNCTIONAL OUTCOME

Also increases potential for SKIN BREAKDOWN

Common sites for contractures include: Hip _, _ and _ _; knee _.

Hip FLEXION, ABDUCTION, and EXTERNAL ROTATION Knee FLEXION

Cardiac, lymphatic, or renal insufficiencies; lack of total contact between limb and prostheses; insufficient ply of prosthetic socks; and improper wrapping of residual limb are all _ _ of _ _

Are all POSSIBLE CAUSES OF DISTAL EDEMA

Distal edema can commonly occur in _ due to changes in _ and _ _ during _ _.

Can commonly occur in FEMALES due to changes in WEIGHT and FLUID RETENTION during MENSTRUAL CYCLE

PT management of amputee pt: physically prepare amputee for _ _ _ and _. _ amputee about _ _ _ and _ of sound limb. Make recommendations for _ _.

Physically prepare amputee for PROSTHETIC GAIT TRAINING and MOBILITY EDUCATE amputee about RESIDUAL LIMB CARE and PRESERVATION of a sound limb Make recommendations for PROSTHETIC COMPONENTS

PT management of Amputee pt: _ amputee how to _ and _for _ and the _ of prosthetic gait. Introduce the amputee to _ _ of _ beyond just learning _ _

TEACH amputee how to USE AND CARE FOR PROSTHESIS and the BIOMECHANICS of prosthetic gait. Introduce the amputee to HIGHER LEVELS OF ACTIVITIES beyond just learning TO WALK

During PT evaluation check: General _, _ (hip _/_, knee _/_), _ (including color, pulse and temperature), _, _ (both UE and LE), and _ (_ or _ _ _ test).

Check: - general APPEARANCE - ROM (hip EXT/ ABD, knee FLEX/ EXT) - VASCULARITY (including color, pulse and temperature) - SENSATION - STRENGTH (both UE and LE) - ENDURANCE (2 or 6 MINUTE WALK test)

PT evaluation: residual limb characteristics- _ and _, _ abnormalities, _ and _ _ length. _ integrity (color/ _, incision _, _ _). Pain (_, _, _)

Residual limb characteristics- EDEMA and GIRTH, SHAPE abnormalities, BONE and SOFT TISSUE length SKIN INTEGRITY (color/ BRUISING, incision SITE, SKIN BREAKDOWN) Pain (INCISIONAL, PHANTOM, NEUROMA)

PT Evaluation: Neurological status (_ and _); balance (_ to _, _ _ _, and _ _ and _ tests); _ _

Neurological status (COGNITION AND MEMORY) Balance (SIT TO STAND, BERG BALANCE SCALE and TIMED UP AND GO tests) FUNCTIONAL MOBILITY

Post op/ pre-prosthesis goals: minimize _ and promote _, prevent _ of _, increase _ and _ _, increase _and _.

Goals: - minimize EDEMA and promote HEALING - prevent LOSS OF ROM - increase LE and UE STRENGTH - increase MOBILITY and INDEPENDENCE

Post op/ pre prosthesis goals: promote _ _ _ and assist with _ _; improve _ and stimulate _; and begin _ _.

Goals: - promote SOUND LIMB CARE and assist with LIMB LOSS - improve BALANCE and stimulate PROPRIOCEPTION - begin CONTROLLED AMBULATION

Post op/ pre prosthesis- positioning for ROM and Edema control: Supine- ensure hips and knees are _ and _ _ _, avoid _ _ of stump. Prone- keep hip and knee _ and avoid _ _.

Positioning for ROM and Edema control: -Supine: ensure hips and knees are STRAIGHT AND HELD CLOSE TOGETHER, avoid EXCESS ELEVATION of stump -Prone: keep hip and knee EXTENDED and avoid HIP ROTATION

Post op/ pre-prosthesis training- positioning for ROM and edema control: Sitting- sit with _ _, keep knees _ by using _ _ or _ attached to w/c. Standing- avoid residual limb _ while _.

Positioning for ROM and edema control: Sitting- sit with LEVEL HIPS, keep knees EXTENDED by using POSTERIOR SPLINT OR BOARD attached to w/c Standing- avoid residual limb FLEXION while STANDING

Temporary prosthesis is comprised of a _ _with a _ liner, adjustable _ set-up and a simple _ _.

Is comprised of a PLASTIC SOCK with a SOFT liner, adjustable PYLON and a simple SACH FOOT

The temporary prosthesis is casted as soon as _ are _ and _ is the _ _ _ in a row

The temporary prosthesis is casted as soon as STAPLES are REMOVED and CIRCUMFERENCE is the SAME FOR 2 WEEKS in a row

Advantages to a temporary prosthesis: _ stump more _, allows for _ _ and earlier return _ _, _ _ and reduces _ _ program

Advantages to a temporary prosthesis: - SHRINKS stump more EFFECTIVELY - allows for BIPEDAL AMBULATION, earlier return TO WORK - POSITIVE MOTIVATION and reduces COMPLEX EXERCISE program

The definitive prosthesis is casted once _ _ has stabilized _ and _. Lasts _-_ _ before anatomical changes in the residual limb _ it's _. Amputee requires a new prosthesis about every _-_ _.

Definitive prosthesis is casted once RESIDUAL LIMB has stabilized SHAPE and SIZE Lasts 1-2 YEARS before anatomical changes in the residual limb REQUIRES it's REPLACEMENT Amputee requires a new prosthesis about every 4-5 YEARS

What are the 5 areas to evaluate when looking at gait with the prosthesis?

BASKS - balance - arm swing - step length - knee FLEXION - stepping

At PT evaluation you may want to _ a _ of the _ _. Be sure to explain why first.

PT evaluation you may want to TAKE A PICTURE of the RESIDUAL LIMB

What are the 3 muscles/ groups whose strength you want to assess in a amputee patient?

- triceps (elbow extensors) - biceps (elbow flexors) - scapular stabilizers

Gait with the prosthesis- statically assess: _, _, and _ _. Dynamically assess: knee and hip _, step _, _ rotation (easiest way to assess is using a _ _), trunk _/ _ swing, and _ of _.

Statistically assess: ASIS, PSIS and ILIAC CREST Dynamically assess: knee and hip FLEXION, step LENGTH, PELVIC rotation (easiest way to assess is using a LASER POINTER), trunk ROTATION/ ARM swing, and BASE of SUPPORT

What is one way to increase arm swing? How can you encourage?

Increase step length You can encourage an increased step length by having patient guesstimate (gives them a cognitive task) how long it will take to get to door (for example)

Ideally when observing gait and analyzing have someone _ _ . Reduces _ _.

Ideally when observing gait and analyzing have someone VIDEOTAPE PATIENT Reduces PATIENT FATIGUE

When assessing deviations in gait in an amputee you need to decide if it is the _ or _ causing the deviation. If it is _ you can _, _ or contact _. If it is the _ you should determine if it is _ or _.

You need to decide if it is the PATIENT or PROSTHESIS causing the deviation If it is the PROSTHESIS you can REALIGN, REFIT, or contact PROSTHETIST If it is the PATIENT you should determine if it is ANATOMICAL or PSYCHOLOGICAL

During gait you should work on stool stepping/ stairs with _ _ and _ _

Work on stool stepping/stairs with SOUND LIMB and PROSTHETIC LIMB

_ _ _ is also very helpful, you can utilize _ or _ _ can help strengthen muscles needed for _, _ and _ _. Backward walking is good for _ _ strengthening

RESISTIVE GAIT TRAINING is also very helpful, you can utilize THERABAND or RUBBER TUBING can help strengthen muscles needed for FORWARD, BACKWARD, and SIDE STEPPING Backward walking is good for HIP EXTENSION strengthening

Initially is a good idea to start _ _ _.

Good idea to start INSIDE PARALLEL BARS

_ or _ _ (_) is a common gait deviation that is often hard to determine which one because it _ _ _. It is named based on the _ _ that the _ _.

MEDIAL or LATERAL WHIP (SWING) is a common gait deviation that is often hard to determine which one because it LOOKS LIKE BOTH It is named based on the FIRST MOTION that the HEEL DOES.

With lateral trunk bending (stance) gait the trunk leans _ _ the prosthetic leg

Trunk leans LATERALLY TOWARDS the prosthetic limb

Most common cause for medial and lateral whip is _ the prosthesis in _ (not _ _ _). May be more _ with _ _.

Is DONNING the prosthesis in MALROTATION (not PUT ON STRAIGHT) May be more PROMINENT with FASTER WALKING