P - Functional Characteristics of TT/TF Amps Flashcards
what is a prosthesis
externally applied device designed to replace the structural and functional characteristics of limb loss
what is a prosthetist
board certified clinician who designs, fabricates, delivers, and maintains prosthetic devices for pts w limb loss
what are prosthetics
specialty w/i field of medicine which describes design, fabrication, application of prostheses
what is the leading cause of amputation
dysvascular dz
what are common comorbidities of dysvascular dz
DM
HTN
dyslipidemia
PVD
PAD
what does the majority of amputations result from
a dz process (neuropathic and vascular process)
what does elevated blood sugar levels cause and why is this relevant
- damage to blood vessels which impairs circulation and affects healing
-> relevant to amp healing and prosthetic timeline - damage to nerve fibers which causes impaired sensation (neuropathy)
–> impaired proprioception to know how socket is sitting on limb and how the foot is being placed
what are 5 typical traumatic causes of amputation
MVA
work-related accidents
violence (gun/war)
severe burns
electrocution
what is the main consideration for the diabetic population
managing elevated blood sugar levels
what are considerations with amputations in a traumatic poulation
may have undergone several limb salvage attempts prior to amp
likely to have significant psych sx (ie grief)
what is the congenital amputee pop often referred to as instead
limb different
what are the 2 categories of congenital pop amputees
transverse
- distal segments affected, prox segments intact
(ex: small hand, normal radius)
longitudinal
- dec/absence occurs w/i long axis of limb, distal segments un affected
(ex: short femur, normal tib/foot - commonly seen in PFMP)
how does surgery for a congenital amp population differ from acquired and why
surgery may be necessary throughout childhood to prep limb for optimal fitting
- bones not growing equally, can stunt the growth so other side can catch up
how does the psych impacts on a congenital amp population differ from acquired
since born w it, don’t necessarily feel like they are missing anything
are LE or UE amps more common
LE 11x more frequent than UE amps
what is the common reason for UE amps vs LE amps
UE: traumatic, congenital
LE: diabetic, dz process
how is an amputation classified
by location
where is a lisfranc amp located
partial foot
- where MT meet tarsal bones
where is a chopart amp located
partial foot
- where tarsal bones meet talus and calcaneus
what are the 2 principles that determine the level of amputation
- adequate circulation to remaining tissue
- preservation of anatomical joints
why is the preservation of anatomical joints an important guiding principle for amputation level determination
the more joints you have to replace and control the harder it is
- want to save as much as possible as appropriate
what is the optimal length residual limb
midlength or 2/3 of original length
what are factors when determining the optimal length for residual limb
- lever arm to control prosthesis and space for suspension
- force distribution
- build height - more gain out of more material there is (more room to store and fit energy)
what is there a constant balance of with when determining optimal residual limb length for a prosthesis
build height with lever arm and suspension
what is a disarticulation amp
going thru joint space but entire bone and proximal articulating condyles are still intact
disarticulation: pros vs cons
pros:
- still have surface designed for weight bearing
(cutting thru middle of bone, part of bone isn’t meant for weight bearing)
cons:
- losing space of componentry for prosthesis
- changes joint center
transfem vs knee disartic outcomes
transfem - more common, do better
- more suspension options
- surface meant for weight bearing
knee disartics harder
- shape is harder for donning bc of size of condyles
- changes knee center (lower) –> impacts gait and step length
what is a syme technique
ankle disarticulation
- disarticulate TC joint
- removal of calcaneus
- trim malleoli
- reposition fat pad and heel soft tissue under distal tib/fib
what are qualities of a syme amputation
shortens leg length
creates WBing surface
- person can functionally amb w/o prosthesis
what is a con of a syme amputation
long residual limb so it’s difficult to fit w good componentry
what are 3 common surgical techniques for a TT amp and what is the most common
**posterior flap
ewing procedure
ertl procedure
what is posterior flap TT technique and what is a common pt complaint
- leave posterior section of tissue longer
- cuts tib and fib (fib shorter than tib)
- sew flap anteriorly
can feel funky like calf is in front bc circulation and nerves are now at bottom on limb
what is an ertl procedure and what are pros and cons
takes some bone from trans tib amp and some of fib bone to make bony bridge
pros: end bearing w/o negatively impacting build height, good WBing surface
cons: more intensive surgery, bone bridge could break
what is ewing procedure and what are pros and cons
attaches agonist and antagonist ms together (reattaches cut ends) so they can continue to function how they usually would
- in prep for long term futuristic tech of mind control for ms activity
pros: less atrophy over time bc can activate ms more than traditional amputee would
- prep for future tech
cons: longer healing process, have to. keep knee straight for 6wks
why is an optimal transfem amp at 2/3
want to keep as much ADD magnus as possible
- major ADD and helps prevent ADD contractures
what is an osseointegration procedure and what are pros and cons
implant rod into center of femur, rod sticks outside the skin tissue
pros: when rod heals, attach component to attach right to prosthesis - eliminating need for a socket
cons: last resort
- would rather fit w traditional socket first bc less invasive
- big risk of infection, always considered an open wound
what is arguably the most important thing to talk about in a pre-amp consultation
managing expectations
what are key points to post op care of an amp (5)
acute surgical pain mgmt
phantom sensation/pain
psych impact
early ed
post-op and pre-pro interventions
what directly influences pt’s future prosthetic success when postop
acute care and early rehab
while interprofessional team member goals post op may vary, what do they have in common
all lead to the same outcome of independent management of a prosthesis
what are 3 goals of surgical/medical team post-op
- healing suture line
- overall health status
- pain mgmt
what are 3 goals of PT/OT team post-op
- desensitization
- edema mgmt / limb shaping
- ROM / strength / mobility
what are 3 goals of prosthetist team post-op
- shrinker fitting
- rigid removable dressing
- prepping for prosthetic fitting
what are the 3 things needed to start the prosthetic fitting
- sutures/staples removed
- minimal drainage present
- cylindrical shape
what is is the progression of drainage presentation postop
drainage transitions from sanguineous to serosanguinous and eventually to serous exudate
what is meant that a residual limb should have a cylindrical shape to start prosthetic fitting and why is this
distal circumference is roughly equal or no more than 1/4’’ greater than proximal circumference
need to push thru socket so don’t want distal bigger than proximal
why is compression an important post op intervention
key w managing edema and pain, phantom sensation
shrinkers vs ace wrap for pre prosthetic compression
shrinkers = compression socks
- implemented right after sutures come out
ace wrap = while sutures are still in
- tightest at bottom and loosest at top
- only as good as last person using it
what is a semi-rigid removable dressing (SRRD) and what are the pros to this as a pre-prosthetic intervention
prevents knee flexion contracture (keeps leg straight)
protects healing residual limb (from falls, common occurrence)
pro: allows for frequent skin checks, easy to apply
what is an IPOP and what are the pros to one
immediate post-op prosthesis
all same benefits as SRRD
allows for early WBing
improved psych acceptance of amp
potential for inc early rehab progress -> starts desensitizing limb and prepping it for WBing
how long does it take from amputation surgery to starting the prosthetic fitting process
6-8wks
what is the giant list of things to get in the IE when doing a prosthetic eval (12)
amp cause and level
med, surg, family hx
personal/social status
current overall health
functional level
goals
ROM
MMT
balance
bony anatomy deformities
cog
sound side condition
what are K classifications important for
used for insurance to determine what prosthesis the pt needs
what are the K-Level classifications
K0: not a candidate
K1: household amb
- one speed, level surfaces
K2: limited comm amb
- one speed, navigate small barriers
K3: community amb
- multiple speeds, uneven surfaces
K4: child/athlete
- high impact/energy levels beyond just walking
what is used to determine the k level
the amputee mobility predictor
how does the amputee mobility predictor work
can admin w pro or w/o pro
structured for interrater reliability for more objective measure
K levels can changed based off these scores
how does coding for prostheses work
code for part of prosthesis, part of body
- make list of codes to explain what they are going to build for pt
what does it mean that prosthetics uses an “add-on” billing system
BKA + socket material + ankle piece
- can add more on from there
what are prescription requirements for prostheses
special Rx for medicare
need original signature on Rx
Rx must include ICD-10 dx
can’t take Rx from DPT
what type of billing does prosthetics follow
lump sum
- pts don’t pay for any visits, only one big fee for prosthesis when it arrives
what is the prosthetic parity bill
every insurance has to pay for 80% ( can be more), it has to match Medicare
how much does Medicare reimburse for prostheses
80%
how much does Medicaid reimburse for prostheses
100% of a reduced list of codes
how much does HMO and private companies reimburse for prostheses
follow individual payment structures
- has to match medicare tho w min of 80%
what are exclusions to insurance reimbursement in prostheses
microprocessor or myoelectric tech
