Prosthetic Management and Training Flashcards
T or F: we have the most evidence for the prosthetic training phase
T: but evidence prior to the use of a prosthetic is limited
are LE or UE amputations more common?
LE
T or F: all patients with amputation receive a prosthetic
F: those who do will need training
Are transfemoral or transtibial amputees more likely to be successful ambulators
TTA
why are UE amputations more common in NC than in some other states
high rates of farming and industrial work
are below knee or above knee amputations more common
below knee
most common age range for amputation
45-84
are amputations more common in males or females
males
what factors that have strong support for predicting walking ability after a lower limb amputation (4)
- amputation level
- age
- physical fitness
- comorbidities
what are two things you can use as early indicators for walking ability following LE amputation
1 - baseline barthel index (ADLs)
2 - ability to stand on intact limb or in tandem
3 clinical assessments associated with walking ability in amputees
1 - 2 minute walk test
2 - one leg balance on unaffected limb and tandem
3 - functional reach
temporary prosthesis can be used once…
surgical incision is healed (10-14 days to 8 weeks post-op)
what is the good thing about temporary prosthesis?
the socket can be changed easier which is good because at this point the residual limb size is not stable
definitive prosthesis is not used until…
the residual limb is stable for 8-12 weeks
what are 2 amputee specific tools to measure pain
1 - prosthesis evaluation questionnaire or the SF 36 health survey
2 - trinity amputation and experience scales
what is the major pressure tolerant area for below knee amputation
patellar tendon and soft tissues around it
how do you check pressure intolerant areas
is it blanchable?
does skin color return to normal in 10 minutes?
what is the most common skin condition with amputations?
contact dermatitis
itchy, raised, circular area on the distal end of a residual limb caused by suction being applied to the end of the limb
verrucous hyperplasia
how is folliculitis usually treated?
topical or systemic antibiotics
*common here because it’s hot
xerosis
dry skin
if your patient has an abscess what should you do
refer to PCP
lack of hip _______ can cause LBP. Why?
extension
b/c you anterior/posterior tilt your pelvis to compensate
prosthetics can accommodate for less than ___ to ____ degrees of hip extension
15-25
but impacts weight shift
what are 4 important variables you should look for in regards to activity limitations
1 - hip ext ROM and strength
2 - symmetrical step length
3 - age
4 - single leg balance
what is a functional closed kinetic chain hip extensor exercise you can do for amputees
single leg bridge on a bolster
*can do similar exercise for abductors
T or F: leg length is important in amputees
T: leg length asymmetry can lead to increased anterior tilt and less hip extension
doing sit to stand or stand to sit amputees often shift to…
their intact side
TTA and TKA have _______ muscle activation in the spinal and abdominal muscles
increased
T or F: falling and fear of falling are pervasive among amputees
T
what are additional assessments you should complete with amputees? (3)
1 - donning and doffing prosthetic (standing and sitting)
2 - check prosthetic fit and footwear
3 - gait
what test is the amputee version of a TUG test
the L test
prosthetic training goals for pts post amputation
1 - build tolerance for prosthetic wear
2 - safety in gait and functional activities
3 - progress to higher level activities
4 - progress the vocational, leisure and sporting activities
variables that play a role in prosthetic prescription (5)
1 - medical history
2 - PLOF and CLOF
3 - body build and type
4 - ROM
5 - availability of support at home
who can order a prosthesis in order to be reimbursed
medical doctor
*at least the doctor has to sign off on what prosthesis wants
if your pt is on hemodialysis what may they need in their prosthesis
socket with removable insert to allow for changes in residual limb size
if your pt has hemiplegia what may they need in their prosthesis
high socket trim lines or thigh corset suspension for increased knee stability
if your pt is very active what kind of prosthetic foot may they need
energy storing
if your pt is obese what may they need in their prosthesis
supracondylar cuff with auxillary fork strap
if your pt works outdoors what may they need in their prosthesis
exoskeleton prosthesis
how many K levels are there? what do they do?
4
dictate what kind of device you will get
K-0 level
wheel chair user
K-1 level
- household ambulator
- has ability to use prosthesis for transfers or ambulation on level surfaces in the home
K-2 level
- community ambulators
- can traverse low level environmental barriers (curbs, stairs, uneven surfaces)
- one cadence
K-3 level
- can modify cadence based on environment and can traverse most environmental barriers
- may be active in low level athletic activities
k-4 level
- child, active adult, athlete
- abilities exceed basic ambulation skills
how do you determine K level
- based on amp pro score
- higher score = higher k-level
socket
contains residual limb
rotator
allows you to rotate device without rotating hip (crossing legs)
pylon
replaces the lower leg
K1 foot (2)
1 - solid ankle cushioned heel
2 - single axis
K2 foot (2)
1 - solid ankle flexible endoskeletal
2 - multiaxial ankle mechanisms
K3 foot (2)
1 - multiaxial ankle mechanisms
2 - dynamic response (energy storing)
*usually carbon fiber
what kind of foot allows you to accommodate for ramps and different shoe types (heels)?
microprocessor
T or F: you can wear different shoe types with prosthesis
F:unless it is a microprocessor foot you have to wear a same or very similar shoe
3 fit and alignment principles for prosthesis
1 - increase residual limb weight bearing capacity (total contact!)
2 - maintain mediolateral stability in midstance
3 - encourage knee flexion in stance
suspension
how the limb is kept on the prosthesis
3 options for TTA suspension
1 - neoprene sleeve
2 - straps
3 - roll on “gel” liners
Pin and shuttle locks make it easy to get the prosthesis on but what is the problem
they are hard to align
In a TTA prothesis, plumb line from midsocket should fall 1/2 inch _______ to mid heel
lateral
Two main types of TFA sockets
1 - quadrilateral
2 - ischial containment
*also new HiFi socket
where do you weight bear with a quadrilateral socket
ischial-gluteal
with a TFA, socket the femur needs to be in slight ___________
adduction
what TFA socket is harder to fit?
ischial containment, but once you get it to dit it is easier to control
TFA suspension options (5)
1 - silicone sleeve
2 - silesian belt (common here)
3 - hip joint and pelvic band
4 - suspenders
5 - roll on “gel” liner
axis options for prosthetic knees
single
polycentric
stability options for prosthetic knees
manual
weight activated
friction options for prosthetic knees
constant variable
fluid control options for prosthetic knees
pneumamtic
hydraulic
_________ axis and ______ locking knees are good for people who are less active
single
manual
____ axis and ______ locking knees are good for people who are active
polycentric
weight-activated
stability at the knee is determined by these two things
1 - individual’s ability to control the knee using muscular power
2 - TKA line
TKA line
trochanter to knee to ankle
are you more stable if TKA line is anterior or posterior to the knee
anterior
the _________ the heel the more stable the knee
softer
keel
forefoot
the ______ the keel the more stable the knee
stiffer
