prosthetic and amputee rehabilitation

Question 1

amputation vs disarticulation (and when each is used)

Answer 1

amputation - the removal of a limb (part or total) from the body, this is generally the preferred method
disarticulation - removing the limb through a joint, preferred in children

Question 2

prosthesis definition

Answer 2

artificial substitute/ replacement of part of the body

Question 3

orthosis definition

Answer 3

devices externally applied to body segments to improve, support, correct or compensate weakness

Question 4

below/above knee amputation name

Answer 4

transtibial; transfemoral

Question 5

above/below elbow amputation name

Answer 5

transhumeral; tansradia

Question 6

congenital limb deficiency name

Answer 6

transverse/longitudinal

Question 7

residual limb name

Answer 7

stump

Question 8

epi. of amputations

Answer 8

50-70yro men generally, lower limb more common

Question 9

common causes for lower/upper limb amputation (4,3)

Answer 9

lower: vascular, traumatic, malignancy, congenital;
upper: trauma, malignancy, congenital

Question 10

when may a hemipelvectomy be performed?

Answer 10

cancer that has spread so far up it affects other organs

Question 11

what will energy requirement depend on (4)?

Answer 11

level of amputation; length of stump; patient’s health/comorbidities; reason for amputation

Question 12

what are the components of the international classification of functioning (ICF)

Answer 12

health (disorder/disease); function (body structure, activities); disability (impairment, problems with body structure, activity limitation)

Question 13

when does rehabilitation start

Answer 13

prior to amputation - counselling is provided for patient + family

Question 14

what is considered when determining suitability for artificial limbs (4)

Answer 14

energy need; contractures; allodynia; cognition

Question 15

what stages are included in rehab medicine - pre amputation (5)

Answer 15

patient education; defining expectations; determining suitability for artificial limb; working with surgeons to choose best operation; phantom limb pain prophylaxis

Question 15

what stages are included in rehab medicine - post amputation (8)

Answer 15

immediately - reduce complications (compare and assess limbs, colour, pulses etc.), maximise independence, minimise pain and discomfort;
post acute - fitness training, preservation of knee function, improve QoL, return to work

Question 16

what is involved in on ward post amputation rehab (5)

Answer 16

wound management (oedema reduction, contracture prevention etc.); preservation of strength + mobility in uninvolved limbs; stump preparation; wheelchair skills; artificial limb fitting/training (measurements, goal establishment, education on skin-care etc.)

Question 17

what does stump preparation involve?

Answer 17

keeping the limb moving to prevent contractures and allows the limb to be straightened; making sure there is no oedema

Question 18

complications of amputation (9)

Answer 18

oedema; infection; ischaemia; non-healing; joint contraction; neuroma forming; phantom limb pain; wound breakdown; bony overgrowth

Question 19

what is a pneumatic post-amputation mobility aid

Answer 19

a prosthesis for a transtibial amp. that consists of a small inflated bag placed on the stump with a larger one outside; there is a metal frame w a simple rocker at the bottom; used early on to reduce stump oedema

Question 20

what is a femurett

Answer 20

a transfemoral prosthesis that has an adjustable socket with a thigh tube; the knee can be locked for walking, unlocked for sitting or in free mode for spring assisted walking

Question 21

gait retraining sequence

Answer 21

1.full weight-bearing and transfer
2.walking with parallel bars
3.walking with 2 sticks between parallel bars
4.walking with 1 stick outside bars
5.optimal gait (w/wo stick)

Question 22

analgesia ladder

Answer 22

Paracetamol
NSAIDs (e.g. naproxen)
Aspirin
Weak opioids (e.g. codeine, tramadol)
strong opioid (e.g. oramorph)

Question 23

how can phantom limb pain be managed (7)

Answer 23

mirror therapy (somatosensory overrides pain); massage; heat; acupuncture; TENS; electromagnestism; VR

Question 24

what can cause stump skin breakdown/ulceration
(6)

Answer 24

poor donning technique; poor socket fit; associated neuropathy; change in stump volume; change in gait pattern; infection w/wo ischeamia

Question 25

components of transtibial prosthesis (6)

Answer 25

socket; suspension mech; adaptor; shin tube; sock/torque absorber; foot

Question 26

components of transfemoral prosthesis (7)

Answer 26

socket; suspension mech; adaptor; knee (locked/unlocked); shin tube; shock/torque absorber; foot

Question 27

what must be considered when prescribing a prosthesis (6)

Answer 27

activity level; amputation level; functional goal; body mass; physical/cognitive abilities; passive/cosmetic/functional (what is it powered by)

Question 28

K activity level

Answer 28

K0: non ambulatory
K1: limited to transfers or limited household ambulator
K2: unlimited household, limited community ambulator
K3: unlimited community ambulator
K4: high energy activities

Question 29

pros/cons of a micro-processor knee prosthetic

Answer 29

pros: improved safety, computer adjusting knee for variable gait cycles, energy saving;
cons: high cost, heavy, daily charging, higher maintenance