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PTH 703 - Unit 2 (Amputations and Protheses) > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

What is the peak age range for amputations?

A

41-70 years old (135K new cases each year in total)

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2
Q

What % of pediatric amputations are acquired?

A

40% are acquired (60% are congential)

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3
Q

Of the acquired amputations, how many are traumatic?

A

70% of acquired amputations (40% of total ampuations) are due to traumatic causes. The other 30% are a result of cancer

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4
Q

How many children are born missing some portion of their limb?

A

1/2000 children are born missing some portion of their limb

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5
Q

What are common causes of traumatic amputations in children?

A

DOORS, lawnmowers, BICYCLES (chains), power saws, and MVAs.

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6
Q

What diseases cause acquired amputations?

A

Primarily cancers.

Osteosacroma (bone)
Ewing’s Sarcoma (lung?)

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7
Q

What are some causes of congenital (embryonic) amputations? (2)

A

Tetrogenic factors

Banding syndromes

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8
Q

How do you manage an acquired, traumatic amputation? (7)

A 
Limb reattachment
Bone grafts
Surgical amputation
Skin grafts
Healing
IPOP
Shaping
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9
Q

How do you manage an acquired amputation due to disease? (4)

A

Surgical removal of tumor
Chemotherapy
Radiation
Limb sparing strategies

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10
Q

What are three goals for an acquired amputation due to disease? (3)

A

Control primary tumor
Control and disease
Preserve function

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11
Q

When do errors in limb development usually occur?

A

4-7 weeks of gestation

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12
Q

When must tetrogenic factors be present?

A

Some time between 3rd and 7th week

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13
Q

What is amniotic band syndrome?

A

Occurs when the fetus becomes entangled in fibrous string-like amniotic bands in the womb, restricting blood flow and affecting the baby’s development.

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14
Q

What are known tetrogenic factors for congenital limb deficiencies?

A

Thalidomide (morning sickness drug with side effect of fetal limb loss), contraceptives, irradiation.

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15
Q

What are four genetic factors linked with limb deficincy?

A

Holt-Oram, Franconi, Nager, and thrombocytopenia-absent radius symdromes

(can also be sporadic mutation)

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16
Q

How are acquired amputations classified?

A

Named for the segment which has been transected (transhumeral, knee disarticulation, etc.)

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17
Q

What are the three Greek-based classifications of congenital limb loss (which we will probably never use but we must be able to recognize)?

A

Amelia, Hemimelia, Phocomelia

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18
Q

What is Amelia?

A

Absence of a limb

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19
Q

What is hemimelia?

A

A shortened or absent limb due to long bone absence or insufficiency

20
Q

What is phocomelia?

A

A congenital with a shortened or absent long bone and webbed hands and/or feet are attached to abbreviated arms and legs. This is often associated with, but not limited to, exposure to thalidomide. Also used when the top part of a limb is missing and distal part is attached to more proximal portion.

21
Q

How are congenital limb losses classified today?

A

Based on amount of development and level

Approved by ISPO and ISO

22
Q

What is the difference between a transverse and longitudinal deficiency?

A

Longitudinal - deficiency is up and down

Transverse - deficiency is L and R

23
Q

What is the clinical presentation of PFFD (a specific birth defect)? (5)

A 
Hip in FABER (frog leg)
Knee flexion contracture
Hypoplasia (underdevelopment) of quads
Small or absent patella
Instability of knee joint due to absence of the ACL and PCL

(overall, ligamentously unstable and stuck in flexion)

24
Q

What is a non-surgical option to treat PFFD

A

“get a big shoe lift”

25
Q

How is PFFD classified?

A

Position of the foot
Length of the femur and tibia
Condition of the hip joint

26
Q

What is a type A PFFD?

A

Present femoral head
Normal acetabulum
Short femoral segment
*Bony connections between components of femur; femoral head in acetebelum

27
Q

What is a type B PFFD?

A

Present femoral head
Adequate or moderately dysplastic acetabulum
Short, usually proximal bony tuft femoral segment
*No osseus connections between head and shaft
Femoral head in acetabulum

28
Q

What is a type C PFFD?

A

Absent femoral head (or represented by ossicle)
Severely dysplastic acetabulum
Short (usually proximally tapered) femoral segment
*May be connection between shaft and proxminal ossicle
*No articulation between femur and acetabulum

29
Q

What is a type D PFFD?

A

Absent femoral head
Absent acetabulum, or obturator foramen enlarged; pelvis squared in bilateral cases
Short, deformed femoral segment

30
Q

What are four non-surgical intervention prinicples for PFFD?

A

Encourage use of the limb; prevent any issues with ROM

Allow for bone growth PRIOR to surgery (do not operate right away) - allow for WB on the natural foot

Initial prosthesis may be fit to accommodate the foot while allowing for growth

Initial prosthesis fit at developmentally apporpriate age (8-10 mo)

31
Q

What are 5 surgical interventions for PFFD?

A

Knee fusion with or without syme app
Van Nes Procedure (similar to rotationplasty)
Limb lengthening procedures such as Ilizarov
Femoral or tibial epiphysoidesis
Amputation of the limb

32
Q

Who is on the treatment team for peds amputees? (7)

A 
Pediatrician/surgeon/oncologist/Nursing
PT/OT
Social worker
Teacher/Early Intervention specialist
Prosthesis
Psychiatrist
Parents/caregiver/family (can be more difficult than the children)
33
Q

What is the role of the PT in the Pre-Prosthetic phase? (3)

A

Promote normal development (interaction with peers/siblings may be most important intervention of all)

EDUCATION of family on activities to prevent loss or ROM, facilitation of normal movement, and minimizing compensation

EDUCATION (again) with care providers, teachers, coaches, etc. to promote inclusion

34
Q

What is the role of the PT in the Post-Prosthetic phase? (4)

A

Try to be involved in the selection of the prosthesis

EDUCATION for donning and doffing of prosthesis

Skin care and education with patient and/or family skin care and protection

Promoting mobility with prosthesis

35
Q

What are 5 considerations for physical therapy?

A 
Age and developmental level
Body type
Other medical management issues
Family dynamics
Interests
36
Q

What are 6 different prosthetic considerations?

A 
Age and developmental considerations
Strength and ROM
Number and location of amputations 
Importance of cosmetics
Activities/lifestyle
Financial issues
37
Q

What are 7 considerations for Infants and Prosthetics?

A 
ROM
Developmental stimulation/positioning
Include family - IMPORTANT!
Encourage interaction with other infants
Crawling, creeping
Sitting balance 
Pull-to-stand (average 10-12 mo) - have to add LE pros.
38
Q

When do you introduce a child to a UE prosthesis?

A

When bilateral hand activities occur (3-4 mo. but could vary). Once you see unilateral activities occur, add UE pros. for bilateral activities.

39
Q

What are 4 considerations for Toddlers/Preschoolers and Prosthetics?

A

Pull-to-Stand (may have been delayed from infancy)
Gait training
Prosthetic training
Family training

40
Q

How can you gait train with toddlers/preschoolers? (3)

A

With device, without prosthesis
With device and prosthesis
With prosthesis, without device

41
Q

What are 4 things you can train the family on if their toddler/preschooler has a prosthesis?

A

Limb shaping
Don/doff
Care of prosthesis
Wearing schedules

42
Q

When along the age spectrum do you begin to involve a child in self-care of their prosthesis?

A 
Elementary Age (8-10)
-Don/doff/skin checks
43
Q

What are 6 considerations for elementary age kids and their prosthesis?

A

Growing prosthesis (kids grow fast)
Environmental access (home/recreation; school/bus/playground/gym class)
Begin to involve child in care!
Adaptive equipment when appropriate
Educate teacher and nurse on don/doff
Can facilitate a classroom presentation with parents permission and typically child absent

44
Q

What are 4 considerations for adolescents and their prosthesis?

A

Should take on primary responsibility for prosthetic care (but may rebel!)
May need more than one prosthesis to accommodate sports/special activities
Peer support and opinion important
Considerations for employment

45
Q

What are traumatic or new disease diagnosis for adolescents? (6)

A

Anger/psychological and psychosocial issues
Phantom sensation issue
Decreased trust of the prosthesis, changes in cog/balance
May need wheelchair while awaiting healing
Will need education: edema, positioning, healing
Should be a part of setting goals

46
Q

What is the #1 cause of amputation in adults?

A

Disease (particularly diabetes and PVD)

47
Q

What are 3 considerations for adults and amputations?

A

Adult amputees are often multi medical pts

Wound healing and closure may take increased time

Childhood amputees grown into adults will experience same aging issues as everyone else

PTH 703 - Unit 2 (Amputations and Protheses) (17 decks)

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