Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PM&R Recap > P & O > Flashcards

P & O Flashcards

1
Q

Most common cause of upper limb amputations?

A

Trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Most common cause of lower limb amputations?

A

Dysvascular disease (PVD, DMT2, factor V Leiden)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Most common suspension system for upper extremity prosthesis?

A

Figure 8 harness

Strap loops around contralateral axilla - acts as counterforce for cable-control action of terminal device

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Potential complications if residual limb doesn’t have total contact w/ socket?

A

Venous choke points –> verrucous hyperplasia, skin breakdown

Exceptions can be made for sensitive areas requiring window cutouts (bony overgrowth, neuroma, skin breakdown sites)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Special wrist consideration for b/l UE amputee?

A

One extremity should have a prosthesis w/ wrist rotation and flexion device that permits access to body midline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Most common body-powered terminal device for UE amputee?

A

Three jaw chuck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Most common set-up for three-jaw chuck body-powered terminal device? (voluntary opening vs. voluntary closing)

A

Voluntary opening

Terminal device remains closed at rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Motion required to flex a prosthetic elbow using a dual-cable control system?

A

Biscapular abduction and humeral depression to flex elbow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Motion required to lock a prosthetic elbow using a dual-cable control system?

A

biscapular depression and humeral extension to lock the elbow in place

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What muscles are used to control a myoelectric below-elbow prosthesis?

A

wrist flexors and extensors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which myoelectric controller setup is preferred for very young children?

A

One-site, one-function controller (also used if amputee does not have two good myoelectric sites)

two-site, two-function = electrodes placed on two antagonist muscles to open and close the terminal device

one-site, two function (“double channel”), uses signals from one muscle to control both opening and closing terminal device (i.e. weak contraction closes, strong contraction opens)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Prosthesis for forequarter amputation?

A

usually passive prosthesis for cosmetic purposes, as prosthesis is challenging to operate/requires special attention towards an acceptable suspension system

Forequarter usually performed due to cancer (includes clavicle and scapula)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Consideration w/ transhumeral amputation length?

A

Longer residual limb is better for patient function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Benefits of elbow disarticulation vs. transhumeral amputation?

A

Surgery is easier, less bloody, functionally = better residual limb than transhumeral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Most common congenital limb defect?

A

Left Transradial defect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Consideration w/ transradial amputation length?

A

The longer the residual limb, the more supination/pronation is preserved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Ideal residual limb shape for transfemoral amputation?

A

conical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Ideal residual limb shape for transtibial amputation?

A

Cylindrical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Optimal spot to amputate for transtibial amputation is where?

A

Within the proximal 50% of the tibia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the difference b/t myoplasty and myodesis?

A

Myoplasty: muscles are sutured together (easier surgery)

Myodesis: muscles are sutured into the bone (more stable surgical result) *not suitable in severe dysvascular patients as will not heal properly)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Difference b/t a Boyd and Pirigoff amputation?

A

Boyd = horizontal calcaneal amputation

Pirigoff = vertical calcaneal amputation

P
i
r
i
g
o
f
f

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

K Level?

Nonambulatory, may need prosthesis to aid in transfers

A

K0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

K Level?

Limited household ambulator, fixed cadence

A

K1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

K Level?

Unlimited household ambulator; limited community ambulator; fixed cadence

A

K2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

K Level?

Unlimited community ambulator, variable cadence

A

K3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

K Level?

High impact activities; sports; variable cadence

A

K4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Increased ambulation energy expenditure for traumatic unilateral transtibial amputee?

A

20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Increased ambulation energy expenditure for traumatic bilateral transtibial amputee?

A

40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Increased ambulation energy expenditure for traumatic unilateral transfemoral amputee?

A

60%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Increased ambulation energy expenditure for traumatic b/l transfemoral amputee?

A

200%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Increased ambulation energy expenditure for dysvascular unilateral transtibial amputee?

A

40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Increased ambulation energy expenditure for dysvascular b/l transtibial amputee?

A

80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Increased ambulation energy expenditure for dysvascular unilateral transfemoral amputee?

A

120%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Increased ambulation energy expenditure for dysvascular b/l transfemoral amputee?

A

400%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Preferred socket design for transfemoral prosthesis?

A

ischial containment socket

Maintains a little thigh adduction and flexion to place the abductors and extensors in a mechanically advantageous stretched position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Which transfemoral prosthetic socket is narrow AP, and wide medial-lateral?

A

Quadrilateral socket

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are pressure tolerant areas for transtibial prostheses?

A

patellar tendon
medial tibial flare
medial tibial shaft
anterior tibial muscles
Fibular shaft
Popliteal fossa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Socket adjustment if venous choking is occuring?

A

adjust number of sock ply worn by the patient or fabricate new socket

Venous chocking occurs when socket is too tight, distal limb hangs in place without contacting socket wall, choking distal venous return

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Cause of transfemoral gait abnormality?

Abducted, circumducted gait, or vaulting on prosthetic side?

A

Prosthesis too long
Inappropriate sizing of socket walls providing discomfort
abduction contracture
patient does not trust knee to bend properly and stabilize them
Poor suspension
Knee unit not flexing properly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Cause of transtibial gait abnormality?

Excessive varus moment

A

Foot is set too far medially
Socket is too abducted

41
Q

Cause of transtibial gait abnormality?

Excessive valgus moment

A

Foot is set too far laterally
Socket is too adducted

42
Q

Cause of transtibial gait abnormality?

Excessive knee flexion

A

Not enough friction built into knee unit
Too much dorsiflexion in foot
Weak quads
Socket placed too far anteriorly
Foot placed too posteriorly, knee flexion contracture

43
Q

Cause of transtibial gait abnormality?

Excessive knee extension

A

Too much friction built into knee unit
Too much plantarflexion in the foot
Weak quads (recurvatum)
Socket placed too far posteriorly
Foot placed too far anteriorly

44
Q

When should a child be fit w/ upper extremity prosthethsis

A

approx 6 months (when sitting w/ support)

“fit to sit”

45
Q

When should a child be fit w/ lower extremity prosthesis?

A

approx 12 months (or sooner, when pulling to stand)

46
Q

What is the most common complication in a pediatric amputee whose growth plates have not yet fused?

A

terminal overgrowth

Most frequently a problem in transtibial amputations (can occur in both acquired and congenital amputations)

47
Q

What principle of orthotics achieves stable manipulation of a joint?

A

3-point pressure principle

48
Q

Most restrictive cervical spinal orthosis?

A

Halo vest

Used in unstable C-spine fractures (such as type 2 dens fracture); bolted to skull w/ 4 pins (invasive, risk for infection)

49
Q

None-invasive alternative to Halo vest that can be used for unstable cervical fractures?

A

Minerva Jacket

large, cumbersome, unappealing, stiff jacket

50
Q

Is a Sterno-Occipital Mandibular Immobilizer (SOMI) more or less restrictive than a rigid Cervical collar?

A

More restrictive

Uses bars that connect to one another from the sternum, occiput, and mandible to limit ROM

Used for STABLE C-spine fractures; can be donned supine

51
Q

Which planes of motion are best restricted by the rigid cervical collars (Philadelphia, Aspen, Miami J, etc)?

A

immobilize both flexion and extension at C5-C6 (especially with thoracic extension

*Does not control lateral bending and axial rotation at C2-3 and C3-4

Used for STABLE cervical fractures

52
Q

Complications/risks of use of soft cervical collars?

A

Atrophy of neck muscles

Soft foam collars do not restrict motion, simply provide kinesthetic reminder - patient preference

53
Q

Orthoses indicated for vertebral body compression fractures/stable burst fractures?

A

Jewett Brace or CASH (cruciform anterior spinal hyperextension orthosis) brace

Prevent hyperflexion of the thoracolumbar spine

*CASH brace is less cumbersome

54
Q

Function of TSLOs in terms of “bracing the core”?

A

Increase intraabdominal pressure, which allows forces to be transmitted into the abdomen, not through the spinal column

55
Q

Brace used for scoliosis correction?

A

Milwaukee Brace

CTLSO - consists of neck ring supported by bars from the thoracolumbar region, which allows for forces to be generated to correct a scoliotic spine

Must be worn at all times (23hrs per day, except for bathing) until skeletal maturity is reached

56
Q

At what Cobb angle is bracing started for scoliosis?

A

20-40 degrees

> 40 degrees - surgical correction considered (>35 degrees for neuromuscular scoliosis)

57
Q

Which TSLO promotes upright spine posture?

A

Taylor Brace/Knight-Taylor Brace

Used similar to Jewett and CASH braces, has straps that wrap around the shoulders (like overalls)

58
Q

Orthosis used in spasticity or burn patients with the goal of preventing contractures?

A

Resting hand splint

59
Q

Positioning of a resting hand splint?

A

Intrinsic plus position

Slight wrist extension, MCP flexion 70-90 degrees, thumb in palmar ABDuction, PIPs and DIPs in extension (functional “C” shape position)

60
Q

Indication for a tenodesis orthosis?

A

Often used in SCI pts w/ NLI of C6 (pt has some wrist extension power, but nothing in C7 roots or below - no hand or finger control)

Brace extends the wrist, approximating the fingers with the thumb, allowing for a more functional grasp by the patient

61
Q

Name of orthosis?

Soft hollow tube that rests in pt’s hand, allowing them to pick up objects ad manipulate them (e.g. fork/spoon)

A

Universal cuff

62
Q

Name of orthosis?

Immobilizes the thumb; can be a long version that prevents radial or ulnar deviation of the wrist as well

A

Opponens orthosis

Immobilizes thumb to allow healing (often for a ligamentous injury or OA of the CMC)

63
Q

Flexion/extension pattern in swan neck deformities?

swan neck ring splint counteracts in which directions?

A

Swan neck:
MCP flexion, DIP extension, PIP flexion

Ring splint: MCP extension, DIP flexion, PIP extension

64
Q

Flexion/extension pattern in Boutonniere deformities?

Boutonniere ring splint counteracts in which directions?

A

Boutonniere”
MCP extension, DIP flexion, PIP extension

Ring splint: MCP flexion, DIP extension, PIP flexion

65
Q

Minimum strength required for use of a balanced forearm orthosis/shoulder-elbow-wrist-hand orthosis?

A

2/5 elbow flexor and 2/5 shoulder girdle strength

Supports the hand, wrist, elbow, and shoulder joint via a complete housing apparatus that allows pt to feed themself

66
Q

When are AFOs w/ double metal uprights indicated?

A

when there is fluctuating limb volume, skin sensitivity, or skin breakdown

67
Q

Role of pins in AFOs?

A

Pins prevent

Anterior = prevents dorsiflexion
Posterior = prevents plantarflexion

68
Q

Role of springs in AFOs?

A

Springs promote

Anterior. = promote plantarflexion
Posterior = promote dorsiflexion

69
Q

Pins in the anterior channel of an AFO will ______?

A

prevent dorsiflexion

70
Q

Springs in the anterior channel of an AFO will ______?

A

assist/promote plantarflexion

71
Q

Pins in the posterior channel of an AFO will _________?

A

prevent plantarflexion

72
Q

Springs in the posterior channel of an AFO will ______?

A

assist/promote dorsiflexion

73
Q

Which AFO is indicated for flaccid foot drop (patient has medial/lateral control of the ankle, and control of progression of the tibia)?

A

Posterior Leaf Spring

Patients w/ pure foot drop, but have medial/lateral control of the ankle and control progression of the tibia

74
Q

Which AFO is indicated for pts w/ significant lower leg weakness but have some tibial control in the sagittal plane?

A

Hinged-solid AFO/Semirigid AFO (trim line just behind the malleoli)

Allows for some sagittal plane movement (which requires more strength to control)

75
Q

Which AFO is indicated for pts w/ significant limb weakness, absent ankle control, spasticity when weight-bearing, knee buckling, and foot drop?

A

Solid AFO

Provides maximum stability while eliminating ankle ROM

76
Q

Which is a more rigid thermoplastic for AFOs:

Polypropylene vs. copolymer

A

Polypropylene

Relatively rigid plastic that is durable, but more difficult to mold than other plastics

*Low-density polyethylene is less rigid, more flexible, and easier to mold

*Copolymer is a blend of polyropylene and polyethylene, provides intermiediate levels of structural rigidity

77
Q

Which orthotic is indicated for patients that have impaired muscular control of the ankle and knee?

A

Knee-Ankle-Foot Orthosis (KAFO)

Often the hinge joint is offset posteriorly to patient’s knee, which causes the line of gravity to fall anterior to the knee, tending to lock it in extension (useful in patients with weak quadriceps whose knees would otherwise buckle)

78
Q

Contraindication for bail lock use in KAFOs?

A

bilateral use

Bail locks automatically lock the KAFO in extension when the knee is extended; to unlock the knee, the patient pulls up on a lever near the knee

79
Q

Type of KAFO indicated for a paraplegic patient with some preserved hip flexion?

A

Scott-Craig KAFO

Allows paraplegic pts to stand without assistance- relies on iliofemoral ligament (posteriorly offset knee joint to passively promote knee extension)

80
Q

Knee orothosis indicated following an ACL tear to prevent further stress to the ligament?

A

Lennox-Hill Derotation Orthosis

81
Q

Knee orthosis indicated to prevent genu recurvatum using a 3-point pressure principle?

A

Swedish Knee Cage

82
Q

Knee orthosis that reduces forces in the foot and ankle?

A

Patellar Tendon-Bearing Orthosis

Uses uprights from the ankle to transmit forces into the patellar tendon so it can share the load of weight-bearing

83
Q

What type of heel wedge should be used to offload the medial compartment of the knee for OA pain?

A

Lateral heel wedge

84
Q

Pros/cons of small caster wheels on a WC?

A

smaller casters = easier to maneuver and turn WC, will get caught on every pebble

standard/optimal size = 8 inch

85
Q

Pros/cons of placing rear WC wheels more anteriorly?

A

Pros: easier to maneuver chair, smaller turning radius, easier to do wheelies and go up curbs

Cons: less stable (easier to tip back going up inclines)

86
Q

Pros/cons of placing rear WC wheels more posteriorly?

A

Pros: more stable

Cons: harder to maneuver, harder to accelerate, harder to ascend inclines

87
Q

Pros/cons of increasing WC camber angle?

A

Pros: allows for really tight turns (i.e. better for WC sports)

Cons: increases width of chair, may not fit through standard doorframes

88
Q

Ideal WC backrest height?

A

just below the bottom corner of the scapula

89
Q

Pros/cons of recline feature in WC?

A

Pros: allows access for I/O cathing

Cons: increases shear forces on back/posterior

90
Q

Ideal cane height?

A

level with greater trochanter, or level of the hand when elbow is flexed 20-30 degrees

91
Q

Prosthetic knee indicated for single-speed walking (can include manually locking feature)?

A

Single-axis/constant friction knee

Very durable, also used for low-build heights

92
Q

Prosthetic knee that locks the knee in extension during weight bearing?

A

Weight-activated stance control (WASC) knee

Good for initial prosthetic training to help with weight shifting, helpful for patients with poor hip control

Must be unloaded to unlock knee for sitting or flexion - causing delayed swing phase; can’t use on stairs

93
Q

Most aesthetically pleasing prosthetic knee for sitting w/ equal leg lengths (low profile)?

A

Polycentric knee

Most commonly has 4 axis points (4 linkage bars), changing center of rotation = very stable during stance, but does not disturb swing phase

useful for long TF or knee disarticulation amputees due to. low profile

94
Q

Prosthetic knees indicated for variable walking speed/cadence?

A

Fluid controlled knee - utilize oil or pneumatic cylinder with piston; hydraulic stance control also improves stability. Cons: heavier, more expensive, requires more maintenance, can be fabricated w/ microprocessor control

Microprocessor knee - allows for variation in both swing and stance phase on a moment-to-moment basis; stumble control features

95
Q

prostetic feet indicated for K1 ambulators?

A

SACH (solid ankle, cushioned heel) foot
- Includes a foam heel and solid wooden keel. Inexpensive, durable, useful in less active amputees, but not energy-efficient. Also useful in Syme amputations

Single Axis Foot
- allows movement in sagittal plane w/ mechanical bumper on either end to modulate dorsiflexion/plantar flexion
- Rapid flat foot can improve knee stability, but can also cause abrupt knee hyperextension (not recommended for trans-tibial amputees)

96
Q

Prosthetic feet indicated for K2 ambulators?

A

Multiaxial foot
- allows motion in the dorsi/plantar flexion lane, and inversion/eversion planes for uneven surfaces (can be costly and heavy)

Stationary ankle, flexible endoskeleton (SAFE) foot
- useful for uneven surfaces

97
Q

Prosthetic foot indicated for K3/K3 ambulators?

A

Energy Storing Foot (aka Dynamic elastic response foot)
- Allows for more dynamic push-off and mechanical energy return; often made of carbon fiber; good for variable cadence

98
Q

Possible causes for circumduction in the gait of a transfemoral amputee include?

A

Excessive mechanical resistance to knee flexion (knee friction too high)
Prosthesis too long
Increased medial brim pressures
inadequate suspension
patient lacks confidence or has inadequate hip flexion

PM&R Recap (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions