Prosthetic Management Flashcards
what is the importance of K levels
determines what prosthetic they get and is important for insurance companies
basic description of K2 level
community ambulator
basic description of K1 level
household ambulator
basic description of K3 level
community ambulator with variable cadence
basic description of K4 level
ambulation exceeds basic skills; exhibits high impact stress and energy levels
what is the most commonly used prosthetic for transtibial amputations
lock and pin
things to be aware of for donning and doffing
make sure its reflected all the way back to avoid blistering and skin breakdown
check alignment of the pin
what are the warning signs of poor skin care
change in color of skin lasting more than 15-20 min
red, irritated or open area on skin
increased pain or edema
calluses or dry cracked skin
wearing schedule of prosthesis
day 1-2: 30 min am and pm
day 3-4: 1 hour am and pm
day 5-10: 2 hors am and pm
day 11-14: full day but remove at lunch and dinner for skin checks
day 14: full time; recommended to check fit once a day
cleaning of inserts and sockests
inserts should be wiped out daily with mild soap and warm water with time to dry. inspect for cracks or damage
sockets should be cleaned out at least weekly by wiping with warm water and towel. clean at night to dry
what incorrect foot placement is more concerning in the sagittal plane
when the foot is placed lateral to the socket. placement tends to cause a rotation of the socket that creates friction and rubbing
what side of the UE should be removed from the parallel bars first during weight shifting activities
remove the sound side UE first and keep the prosthetic limb as the stance leg
what muscles are active to stabilize the body during prosthetic stance activities
hip extensors and hip AB
what key element are you working on during initial ambulation in the parallel bars
working on facilitating pelvic rotation. important to restore this by using manual cuing for normal gait pattern
what type of gait pattern on the stairs does someone with a transfemoral amputation usually have
step to pattern
what type of gait pattern on the stairs does someone with a transtibial amputation usually have
step over step pattern
what is the purpose of loading the prosthetic toe
to achieve knee flexion
which side of the body would be able to achieve more arm swing
more arm swing on the sound side due to the fact that there is less rotation on the prosthetic side
what happens to the knee when there is posterior displacement of the socket over the foot
the knee is extended for too long because the foot is too far forward
reasons for why the knee remains extended along with corrections
- foot is too anterior (move foot posteriorly to correct)
- foot is too PF (move foot into DF to correct)
- excessive use of knee extensors or weak quads (strengthening and gait training to correct)
what occurs with anterior displacement of the socket
excessive knee flexion
causes and corrections of knee flexion
- foot too posterior (move foot anteriorly to correct)
- foot too DF (move foot into PF)
- weak knee extensors (quad strengthening to correct)
with what type of amputation does lateral trunk bending always occur
hip disarticulation
causes and corrections for lateral trunk bending
prosthesis too short (measure leg length to correct)
RL pain (evaluate fit and need for additional socks to correct )
weak RL ABductors (abductor strengthening exercises to correct)
what is a correction for wide based gait
move the foot medial
what is a simple correction for a narrow based gait
move the outset foot laterally
how is the direction of a whip determined
named for what the heel is doing
why would vaulting occur
in transfemoral if the prosthesis is too long
why would circumduction occur
in transfemoral if the prosthesis is too long, poor suspension or difficulty flexing the knee
cause of unequal stride length
fear of putting weight through the prosthetic limb
causes and corrections of lateral trunk bending in TRANSFEMORAL
weak AB (strengthen abductors) high medal wall of prosthesis (modify prosthesis ) short prosthesis (lengthen prosthesis) AB contracture (stretch AB) instability (balance training) foot outset too far (move foot medially)
causes and corrections of pistioning
socket too loose (add socks, assess fit)
inadequate suspension (assess suspension)
improper donning (patient education)
causes and corrections of circumduction
long prosthesis (shorten it) excessive PF ( move foot into DF) weak hip flexors (strengthen hip flexors) abductor contracture (stretch abductors )
what motion at the hip is crucial for knee stability in stance
hip extension
causes and corrections of whips
improper alignment of knee joint in relation to the socket (realign knee)
what is the knee joint set in for a medial whip to occur
external rotation
what is the knee joint set in for a lateral whip to occur
internal rotation
why do people with transfemoral amputations need hip extension
controls knee extension
how would a silesian bandage be a helpful correction for whips
coming above the waist can help control the rotation from below
possible causes of instability at the knee
malfunction of stance control knee
weak hip extensors
hip flexor contractuure
excessive DF
What occurs during an audible snap
terminal knee extension before heel strike
possible causes of terminal swing impact
insufficient knee friction
fear of buckling causes pt to forcefully extend the hip
possible causes of foot rotation at heel strike
stiff heel cushion malrotation of the foot poor hip control weak hip rotators socket too loose
possible causes of uneven step length
hip flexion contracture
excessive knee friciton
pain on prosthetic limb
prosthesis too long
what side of the body will have a shorter step length and why
the sound side will have a shorter step length because they don’t want to stand for a long time on the prosthetic side
what is the main cause of uneven arm swing
not enough pelvic rotation
possible causes of drop off at terminal stance
inadequate DF resistance
foot positioned too far posterior
foot too DF
stride too long on sound leg
possible causes of lordosis (excessive trunk extension)
hip flexor contracture
weak hip extensors and abdominals
excessive anterior pelvic tilt
inadequate socket flexion
possible causes of excessive heel rise
insufficient knee friction
forceful hip flexion to ensure adequate knee extension and cleareance
causes of excessive knee flexion in early stance
SACH heel too firm
foot set in too much DF
knee axis too anterior to hip and ankle
severe hip flexor contracture
causes of pisitioning
socket too loose
inadequate suspension
improper donning
what does pisitioning do to the limb
lengthens the limb
what gait deviations are more common for transfemoral
vaulting circumducted gait unequal stride length lateral trunk bending abducted gait hip hiking whips excessive heel rise pistioning lordosis drop off decreased arm swing foot rotation at heel strike terminal swing impact
what gait deviations are more common for transtibial
knee hyperextension excessive knee flexion lateral trunk bending wide based gait delayed knee flexion
