PT Management of Prosthetics Flashcards
what are the phases of care in prosthetics?
pre-surgical
post-surgical
pre-prosthetic
prosthetic prescription
prosthetic exam/training
what two factors can pose a large barrier to prosthetics?
available ROM
positioning
who makes the adjustments on prosthetics?
the prosthetist
who are the team members for prosthetics management?
PT
OT
prosthetist
physician
psychologist
what are the goals of prosthetics management?
smooth and efficient gait
ADL performance
acceptance of body weight on each leg at initial contact
single leg balance on each LE
symmetry of stance time
spinal stability during swing and stance phase
symmetrical step length
adaptation to various environments
how do we create spinal stability?
by minimizing pelvic tilt and frontal plane compensations
what are the PT roles in prosthetics management?
address the non-prosthetic issues (or skin integ)
contribute to prosthetic prescription
examine the prosthesis
facilitate prosthetic acceptance
instruct pt in donning, use, and maintenance of the prosthesis
what is sock ply?
the ability to modify acceptance of a limb into a prosthetic
t/f: sock ply is not something PTs have much to do with
false, this is something we WILL change and have to be able to teach the pt
what things do we want to look at in the examination for prosthetics?
AROM/PROM of BLE
length of residual limb
strength of all limbs and trunk musculature
sensory exam
skin/integ inspection
memory
circulation
aerobic capacity
fxnal exam
psychosocial awareness
why do we want to look at the length of the residual limb?
bc it will impact the suspension systems
what is an important sensory system fxn to consider with prosthetics? why?
proprioception at the knee bc it will impact knee stability
when should we do a skin inspection with prosthetics?
before and after treatment
why do we want to include memory in our exam?
bc they will need to be able to learn new info
why do we want to consider circulation and anthropometric findings in our exam?
bc they will impact the sock fit and management
what is included in a fxnal exam?
transfers
STSs
bed to/from WC
what are the two broad categories of analysis we want to complete at the eval?
static analysis
dynamic analysis
what type of analysis involves looking at how the pt looks in standing w/ and w/o the prosthesis?
static analysis
what type of analysis involves looking at pts during gait?
dynamic analysis
where should we begin the static analysis for TTA?
in the parallel bars to attempt equal WBing
what should we assess for during static analysis in TTA?
comfort
AP, ML alignment by slipping paper under prosthetic shoe if there is bad WBing
pelvic postition/level
piston action
sitting position and posterior brim on the popliteal fossa
in severe cases, we may use a ____ _____ to normalize pelvic position <1/2 in
shoe lift
what is the piston action?
the vertical motion of the socket when the pelvis is elevated
the residual limb moving in/out of the socket with weight shifting
in the piston action, the residual limb should slip <____in
1/4
how do we measure the slip with the piston action?
with chalk on the person
t/f: we are almost always going to see some form of “gait compensation” in pts using prosthetics
true
t/f: no prosthesis restores sensation, skeletal continuity, muscles integrity, or full body weight
true
what are some common prosthetic causes of gait compensations?
poor fitting socket (likely due to fluctuant edema)-big one
prosthetic misalignment
malfunctioning components
improper height of prosthesis - big one
inappropriate donning
inappropriate shoes
what should be the focus during the dynamic analysis of TTA?
the action of the knee of the amputated limb during stance phase
what does too much knee flexion of the residual limb in stance in TTA dynamic analysis indicate?
the socket is too far anterior relative to the foot
what does too much knee extension of the residual limb in stance in TTA dynamic analysis indicate?
the socket is too far posterior relative to the foot
what does too much knee flexion of the residual limb in early stance in TTA dynamic analysis indicate?
the heel cushion is too firm
t/f: problems often start at the knee and move to the pelvis and trunk
true
during late stance, what are some prosthetic causes of early knee flexion/ “drop off”?
shoe heel is too high
insufficient PF
DF stop is too soft
socket is too anterior
socket is excessively flexed
during late stance, what is an anatomical cause of early knee flexion/ “drop off”?
flexion contracture
during late stance, what are some prosthetic causes of delayed knee flexion/ “perception of walking uphill”
shoe heel is too high
excessive PF
DF stop is too stiff
socket is too posterior
socket is insufficiently flexed
during late stance, what are some anatomical causes of delayed knee flexion/ “perception of walking uphill”
extensor spasticity
what is involved in TTA static analysis (off patient)?
checking for skin redness or breakdown on the residual limb
checking the height of the anterior wall vs the posterior brim
do prosthetics with TFAs or with TTA tend to be more uncomfortable? why?
prosthetics with TFAs tend to be more uncomfortable bc they go into the sensitive area of the groin and buttock
the more ___ the knee bolt, the most stable the knee is
posterior
what should we examine in the TFA static analysis?
flesh roll above the socket/peripheral pressure and pain
maintenance of extension of the hip
proper location for the adductor longus and ischial tub in the quadrilateral socket
WBing on the ischial tub on the “shelf” of the quadrilateral socket
sitting ability
in the TFA dynamic analysis, if there is abduction, what are some possible prosthetic causes?
prosthesis is too long
hip joint is abducted
lateral wall is inadequately adducted
medial wall is too sharp or too high
in the TFA dynamic analysis, if there is abduction in stance, what are some possible anatomical causes?
abduction contracture
weak abductors
lateral/distal pain
adductor redundancy instability
what is probably the most common compensation/deviation we will see for lateral displacements?
circumducting gait
in the TFA dynamic analysis, if there is circumduction in swing, what are some possible prosthetic causes?
prosthesis too long
knee unit is locked
friction is insufficient
suspension is inadequate
the socket is too small
the socket is too loose
the foot is PFed
in the TFA dynamic analysis, if there is circumduction, what are some possible anatomical causes?
abduction contracture
poor knee control
in the TFA dynamic analysis, if there is lateral bend in stance, what are some possible prosthetic causes?
prosthesis is too short
lateral wall is inadequately adducted
medial wall is too sharp or too high
in the TFA dynamic analysis, if there is lateral bend in stance, what are some possible anatomical causes?
abduction contracture
weak abductors
hip pain instability
short amputation limb
in the TFA dynamic analysis, if there is fwd flexion in stance, what are some possible prosthetic causes?
knee unit is unstable
walker or crutches are too short
in the TFA dynamic analysis, if there is fwd flexion in stance, what are some possible anatomical causes?
instability
in the TFA dynamic analysis, if there is medial/lateral whip at heel off, what are some possible prosthetic causes?
socket contour is faulty
knee bolt is externally/internally rotated
foot is malrotated
prosthesis is donned in malrotation
in the TFA dynamic analysis, if there is medial/lateral whip at heel off, what are some possible anatomical causes?
with load-dependent friction unit
with fast pace
in the TFA dynamic analysis, if there is foot rotation at heel contact, what are some possible prosthetic causes?
heel cushion is too stiff
in the TFA dynamic analysis, if there is heel rise in early swing, what are some possible prosthetic causes?
friction is insufficient
extension aid is slack
in the TFA dynamic analysis, if there is terminal impact in lateral swing, what are some possible prosthetic causes?
friction is insufficient
extension aid is taut
in the TFA dynamic analysis, if there is terminal impact in lateral swing, what is a possible anatomical cause?
forceful hip flexion
in the TFA dynamic analysis, if there is vaulting in swing, what are some possible prosthetic causes?
prosthesis too long
knee unit is locked
friction is insufficient
suspension is inadequate
the socket is too small
the socket is too loose
the foot is PFed
in the TFA dynamic analysis, if there is vaulting in swing, what is a possible anatomical cause?
fast pace
in the TFA dynamic analysis, if there is hip hike in swing, what are some possible prosthetic causes?
prosthesis too long
knee unit is locked
friction is insufficient
suspension is inadequate
the socket is too small
the socket is too loose
the foot is PFed
in the TFA dynamic analysis, if there is hip hike in swing, what are some possible anatomical causes?
weak DFers
PF spasticity
pes equinus
weak hip flexors
in the TFA dynamic analysis, if there is uneven step length, what are some possible prosthetic causes?
socket is uncomfortable
socket is inadequately flexed
in the TFA dynamic analysis, if there is uneven step length, what are some possible anatomical causes?
hip flexion contracture
instability
what is involved in prosthetic training?
donning
exercises to stretch and strengthen
balance and coordination training
what do we have to teach pts about donning?
the correct application
frequent inspection
correct sequencing of componentry/suspension/socks etc
what exercises should we include for stretching and strengthening?
hip flexor stretching
isometric multi-directional hip strength
where should we start balance coordination training?
in the parallel bars with open hands
what things should be included in balance and coordination training?
static balance with level pelvis and shoulders
weight shifting to the prosthesis
mirror feedback
progression to ML, sagittal, and rotary control in dynamic exercises
what are the goals of strengthening?
to improve weakness found in the exam
to maximize strength and endurance of ms
to decrease energy expenditure of the prosthesis
what ms groups do we target in strengthening?
glutes !!!
abdominals
back extensors
quads
t/f: we must obtain a close fit bw the sock and the limb with a prosthetic
true
what is involved in pt Ed with prosthetics?
proper fit
WBing areas
sensations
what is the proper alignment of the patella in a TTA prosthetic?
the patella should sit right above the trim line
if there is a decreased limb volume, what will happen to the alignment of the patella in the prosthetic?
there will be increased contact from it sinking into the prosthetic
if there is a increased limb volume, what will happen to the alignment of the patella in the prosthetic?
the patella will sit too far up
t/f: there should be no distal pressure on the residual limb in a proper fitting prosthesis
true
if there is distal pain of the residual limb in the prosthesis what could this mean?
that they’re bottoming out and sinking into the prosthetic too much
what is involved in postural control in the pre-prosthesis phase?
sitting balance
AD training
transfers
what is involved in postural control in the prosthetic training phase?
core stability
equilibrium responses (adaptive and reactive)
control of new COM
what are the main two components of skin care in prosthesis care?
proper hygiene
edema prevention
what problems related to prosthetic shear or friction may occur when wearing the prosthesis?
abrasions
blisters
edema
bacterial infections
boils
t/f: the skin and sock must be washed regularly and dried to keep them clean
true
why should cleansing products or perfumes containing alcohol be avoided on the amputated area?
to avoid drying and cracking of the skin
t/f: edema is exacerbated in higher temps
true
if edema is not prevented, what may result?
discoloration
blisters
ulcers
what are some general edema management strategies?
stretching
compression
using elastic bandages
pneumatic or cooling compression
lymph node massage
HVPC
in severe cases of edema, what may be used for management?
meds like anti-inflammatories or injections of corticosteroids
t/f: PTs must consider the types of componentry in training bc some skills are specific to certain prosthesis components
true
t/f: we must maximize time training with an AD
false, we must maximize training w/o external support
t/f: a RW will have sig impacts on the transverse plane movts
true
gait training is used to improve…
quality and efficiency of gait
t/f: we should avoid overuse do the intact LE in gait training with a prosthesis bc it can lead to numerous MSK problems in the knee and back most commonly
true
what are the goals of gait training?
to improve spatiotemporal and kinematics symmetry and bioenergetics of gait
what are some options we have available for gait training with prosthesis?
treadmill, VR, bodyweight support, and gaming (ie Wii Fit)
in prosthetic gait training, there is emphasis on what?
symmetric performance
do we want greater load through the intact or residual limb in gait training with a prosthesis?
through the intact limb
in prosthetic gait training, the primary focus is on strengthening what ms?
HS
do we want to work on step length in prosthetic gait training?
yes
do we want to work on changing directions in prosthetic gait training?
yes
do we want to work on inclines/declines in prosthetic gait training?
yes
do we want to work on ability to adapt to changes in surfaces in prosthetic gait training?
yes
what is involved in fall management?
teaching the pt how to safely fall and get back up
what is involved in advanced gait training?
changes in environments (obstacles, variable surfaces, picking up objects, carrying items)
steps and ramps
with descent, why does the pt always have to place the prosthesis on the edge of the step?
lack of DF
t/f: TFA will need to strategically lock/unlock the knee pending scenarios like walking down a steep hill
true
what are the self-reported outcomes we can use in prosthesis users?
prosthetic evaluation questionnaire
locomotor capabilities index
ABC
what are the fxanl outcome measures we can use in prosthesis users?
TUG
6MWT
2MWT
AMPRO and AMnoPRO
