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Cuccurullo Board Pearls > Prosthetics And Orthotics > Flashcards

Prosthetics And Orthotics Flashcards

1
Q

Lowest center of gravity in gait cycle?

A

Loading phase

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2
Q

Highest center of gravity in gait cycle?

A

Midstance

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3
Q

Location of center of gravity during gait?

A

5cm anterior to S2 vertebra

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4
Q

Components of stance phase?

A

Initial contact (heel strike)
Loading response (foot flat)
Mid stance
Terminal stance (heel off)
Preswing (toe off)

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5
Q

Components of swing phase?

A

Initial swing (acceleration)
Mid swing
Terminal swing (deceleration)

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6
Q

Determinants of gait

A

Pelvic rotation
Pelvic tilt
Knee flexion (stance phase)
Foot mechanisms
Knee mechanisms
Lateral displacement of the pelvis

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7
Q

Cause of trendelenburg gait?

A

Weak hip abductors (glute med and min), loss of pelvic stabilization, hip drop in contra lateral side

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8
Q

Probable cause of foot slap?

A

Weak dorsiflexors (at most 3/5)

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9
Q

Probable cause of genu recurvatum?

A

Weak, short, or spastic quads; compensated hamstring weakness, Achilles tendon contracture, plantar flexor spasticity

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10
Q

Probable causes of excessive foot supination during gait?

A

Compensated forefoot valgus deformity
Pes cavus
Short limb

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11
Q

Probable causes of excessive trunk extension during gait?

A

Weak hip extensors or flexors
Hip pain
Decreased knee ROM

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12
Q

Probable causes of excessive trunk flexion during gait?

A

Weak gluteus maximus and quads
Hip flexion contractures

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13
Q

Probable causes of excessive knee flexion during pre-swing?

A

Hamstring/hip flexion contracture
Increased ankle dorsiflexion
Weak plantar flexion
Long limb

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14
Q

Probable causes of excessive trunk lateral flexion during loading?

A

Compensated trendelenburg gait: ipsilateral glute medius weakness, hip pain

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15
Q

Gait pathology: stooped posture, festinating (shuffling) gait, decreased arm swing, reduced trunk rotation

A

Parkinson’s Disease
Also characterized by start hesitation and freezing

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16
Q

Primary disturbance in Parkinson’s gait?

A

Reduced step length

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17
Q

Gait impairment seen in duschenne muscular dystrophy?

A

Toe walking - stance phase w/ plantar flexion to maintain a weight line posterior to the hip and anterior to extended knee to compensate for weak knee extensors or for increased lumbar lordosis (which itself is compensating for weak hip extensors)

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18
Q

Gait impairment seen w/ hip flexion contracture? Energy expenditure increase?

A

increased anterior pelvic tilt, decreased contralateral step length, increased knee flexion

Increase energy expenditure: a 35 degree contracture due to iliopsoas tightness results in 60% increase in energy consumption

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19
Q

Increased energy expenditure in wheelchair users with paraplegia?

A

9% increase

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20
Q

Energy expenditure for crutch walking?

A

Increased compared to walking with a prothesis

Muscles that need strengthening in preparation for crutch walking: latissimus dorsi, triceps, pectoralis major, quads, hip extensors, hip abductors

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21
Q

Increased energy expenditure for syme’s amputation?

A

15%

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22
Q

Increased energy expenditure for traumatic transtibial amputation?

A

25% (short tibia 40%; long tibia 10%)

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23
Q

Increased energy expenditure for traumatic b/l transtibial amputations

A

41%

24
Q

Increased energy expenditure for traumatic transfemoral amputation

A

60-70%

25
Q

Increased energy expenditure for traumatic b/l transfemoral amputations?

A

> 200%

26
Q

Traumatic transfemoral and transtibial amputations?

A

118%

27
Q

vascular transtibial BKA?

A

40%

28
Q

Increased energy expenditure for vascular transtibial BKA?

A

40%

29
Q

Increased energy expenditure for vascular transfemoral AKA?

A

100%

30
Q

Increased energy expenditure for hip disarticulation?

A

100-200%

31
Q

Risk factor for vascular amputation that contributes to 2/3 of all lower extremity amputations?

A

Diabetes (prevalence of PVD is 20% higher in diabetic population)

32
Q

Leading cause of upper extremity amputation?

A

Trauma - 80% of UE amputations, majority of limited to digital amputations

33
Q

When is amputation considered for mangled hand?

A

If irreparable damage occurs to four of the six basic parts: skin, vessels, skeleton, nerves, extensor, and flexor tendons.

Initial goal: save all feasible length

34
Q

Most common upper extremity amputation?

A

trans-radial - allows for high level of functional recovery in majority of cases

35
Q

Most common upper extremity terminal device?

A

Body-powered voluntary opening

36
Q

Importance of wrist flexion unit in UE amputees?

A

allows terminal device to be in flexed position, facilitates ability to perform activities close to the body

37
Q

Which socket designs work well for short residual upper extremity limbs?

A

Split socket - consists of total-contact segment encasing the residual limb that is connected by hinges to a separate forearm shell to which the wrist unit and terminal device are attached

Meunster socket (self-suspended socket); the socket and forearm are set in a position of initial flexion; socket encloses the olecranon and epicondyle of the humerus

38
Q

Most commonly used harness suspension system for transradial amputations?

A

Figure 8 (O-ring) harness

Axilla loop, worn on intact side, acts as a reaction point for transmission of body force to the terminal device

39
Q

Prosthesis for elbow disarticulation?

A

Variation of transhumeral prosthesis - socket is flat/broad distally to conform to epicondyles, which provides self-suspension and allows for internal/external rotation of the humerus. Length of the residual limb requires use of external elbow joint w/ cable-operated locking mechanism. Harness and control system = same as transhumeral prosthesis.

40
Q

Harness design for the most frequently used transhumeral prostheses?

A

modifications of the basic figure-8 and chest strap patterns that are used with transradial prostheses

41
Q

Muscle groups used for myoelectric control in below-elbow amputees?

A

Wrist extensors (ECRL/B & ECU) are used to open the terminal device

Wrist flexors (FCR & FCU) are used to close the terminal device

42
Q

Muscle groups used for myoelectric control in above-elbow amputees?

A

Biceps - flex elbow and close terminal device
Triceps - extend elbow and open terminal device

*With short transhumeral or shoulder amputation, shoulder girdle muscles are used to control elbow function and terminal device function

43
Q

Advantages and disadvantages of body-powered upper extremity prostheses?

A

Advantages: less expensive, lighter, more durable, easier to repair, higher sensory feedback

Disadvantages: mechanical appearance, difficult to use for some people, dependent on motor strength

44
Q

Advantages and disadvantages of myoelectric upper extremity prostheses?

A

Advantages: better cosmesis, less harnessing, stronger grasp force

Disadvantages: more expensive, heavier, decreased durability due to electronic components and the need for daily recharging of batteries

45
Q

Most common cause of upper limb amputation

A

Trauma (distal > proximal)

46
Q

Most common cause of lower limb amputation?

A

Dysvascular disease (PVD, DMT2, factor V Leiden), distal > proximal due to compromised vasculature

47
Q

Complications if a prosthesis socket wall does not remain in contact with all parts of the limb?

A

Venous choke points leads to skin breakdown, warts (verucus hyperplasia)

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

48
Q

Most common congenital limb defect?

A

left transradial - the longer the residual limb, the more pronation/supination function remaining

49
Q

Ideal residual limb shape for transfemoral amputation?

A

conical

50
Q

Ideal residual limb shape for transtibial amputation?

A

cylindrical (optimal spot to amputate is within proximal 50% of tibia

51
Q

What level is a Syme amputation?

A

everything below the tibia, calcaneal fat pad is placed below tibia, can bear weight (low-level ambulator)

52
Q

Myoplasty vs. Myodesis

A

Myoplasty: muscles are sutured to each other (easier surgery)

Myodesis muscles are sutured to the bone - more stable surgical result (not suitable in severely dysvascular patients as this will not heal properly)

53
Q

Which motions are most affected in upper extremity amputations?

A

Transhumeral amputations: 80% have limitations of numeral rotation
Transradial amputations: 80% have limitations in forearm rotation

54
Q

Diagnostic criteria for peripheral artery disease/peripheral vascular disease

A

ABI (ratio of brachial systolic pressure to ankle systolic pressure)
0.91 - 1.30 Normal (> 1.30 may suggest calcified, non-compressible vessels - common in diabetes, can produce false negatives)
0.71 - 0.90 mild PVD
0.41 - 0.70 moderate PVD
0.00 to 0.40 severe PVD

*If ABI is abnormal, Doppler waveform localizes the lesion
*Itra-arterial contrast angiography is the gold standard imaging test for PVD (invasive, should not be used for screening)

55
Q

Level of lisfranc amputation?

A

Tarsometatarsal junction

56
Q

Level of Chopart amputation?

A

Removes all of the tarsals and metatarsals. Only the talus and calcaneus remain

57
Q

What foot deformity is common in Lisfranc and Chopart amputations?

A

Remaining foot develops a equinovarus deformity resulting in excessive anterior weight bearing with breakdown. Adequate dorsiflexor tendon reattachment w/ Achilles tendon lengthening has been advocated for to prevent this deformity

Cuccurullo Board Pearls (5 decks)

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