quiz 1 (1-5) Flashcards
prosthesis
a device that replaces a missing limb (noun)
prostheses
plural of prosthesis
prosthetic
describes a device (adjective)
prosthetics
the study of or practice of working with prostheses
prosthetist
a person who practices prosthetics
CP
certified prosthetist
CO
certified orthotist
CPO
certified prosthetist & orthotist
~7500 in US
how many people in the US are living with an amputation?
> 2 million
how many new amputations per year?
185,000
what is the cause of most LE amputations?
vascular disease (82%)
what is the cause of most UE amputations?
trauma
top 4 causes of amputation
- diabetes
- trauma
- cancer
- congenital deficiencies
clinical signs of peripheral neuropathy
-deficits of sensation
-motor impairments
-auto dysfunction
4 classic signs & symptoms of PAD
- intermittent claudication
- loss of 1 or more LE pulses
- leg numbness
- trophic changes
risk factors for PAD
smoking, age, diabetes, HTN, heart disease, CVA
Leading causes of trauma causing amputation
MVA, farming accident, power tools, firearms, burns/ electrocution
typical trauma patient profile
men 20-29
cancer related amputation patient profile
osteosarcoma at distal femur, proximal tibia or humerus. male childhood- early adulthood
osteosarcoma red flags
pain with weightbearing, deep local pain, fractures
challenges of congenital deformity
rapid growth, cosmesis, provide for function
diabetic foot screen risk category 0
diabetes but no loss of protective sensation
diabetic foot screen risk category 1
diabetes, loss of protective sensation in feet
diabetic foot screen risk category 2
diabetes, loss of protective sensation in feet with high pressure or poor circulation
diabetic foot screen risk category 3
diabetes, hx of plantar ulceration or neuropathic fracture
foot screen management category 0
follow up yearly
foot screen management category 1
follow up 3-6 months
foot screen management category 2
follow up 1-3 months
foot screen management category 3
follow up 1-12 weeks
acute phase
time between surgery and discharge from acute care
pre-prosthetic phase
time between discharge from acute care and fitting with a definitive prosthesis or until deciding not to do prosthesis
prosthetic phase
long term management includes rehabilitation and training with prosthetic
amputation prevention procedures for peripheral arterial disease
-angioplasty/ stenting
-LE bypass graft
amputation prevention procedures for osteosarcoma & trauma
limb salvage procedure
factors affecting level of amputation
-vascular disease
-postoperative function
-disarticulations
-trauma & malignancy
what is myoplasty
attachment of anterior and posterior compartment muscles to each other over the end of the bone. better if you have ischemia
what is myodesis
anchoring of muscles to bone. increases stability, muscular control, and proprioception
when would equal length anterior/ posterior flap be used?
when conserving bone length or if primary healing is not concerned
when would a long posterior flap be used?
when vascularity is of concern or when padding is needed
when would a skew sagittal flap be used?
-in severe dysvascular cases to take advantage of saphenous nerve/artery & sural nerve
-remove anterior placement of scar from high prosthetic pressures
helps with blood flow laterally
what is the shortest level of a TTA compatible with knee function
tibial tubercles
how much shorter is the fibula from the tibia for limb shaping in a TTA
1 cm
historically what was the most common amputation level for people with poor circulation or gangrene?
transfemoral
reasons for choosing transfemoral vs transtibial
-trauma
-gangrene spread to the knee
-circulatory status indicating poor chance of healing
in a transfemoral amp, the limb is maintained in ________ & ________ during surgery to maintain proper alignment
extension, adduction
common issues with transfemoral amp
-hip adductor roll
-hip flexure contracture
-hip abduction contracture
-glute weakness
common issue with transtibial amp
knee flexion cotracture
contractures can lead to …
pain, pressure ulcers, further immobility, and functional deficits
osseointegration
connection of bone to prosthetic limb. eliminates need for socket, short residual limb, more natural, improved gait, allows normal swelling
downsides to osseointegration
-multiple surgeries
-prolonged no ambulation
-risk of fracture
-reduction in high torque activities
-not well known in US
hemicorporectomy
below wait amputation, both legs amputated
transpelvic
amputation of portion of pelvis and lower extremity
hip disarticulation
amputation through hip joint capsule including the entire lower extremity
reasons for a knee disarticulation
-inability to provide adequate transtibial amputation secondary to trauma
-knee flexion contracture >45
-congenital deformities
reasons for an ankle disarticulation
severe foot trauma
congenital abnormalities
gangrene
reasons for a transmetatarsal amp
-infection due to dysvascularity or diabetes
-trauma
primary dressing
gauze pads and kerlix
secondary dressing
ace wrap, tubing dressing, shrinker
mature transtibial residual limb should look like
a tapered cylindrical shape with distal circumference slightly less than proximal circumference
mature transfemoral residual limb should look like
more conical shape, with distal circumference slightly less than proximal circumference
attention & cognition assessment should not forget to screen for …
delirium, depression, and fear avoidance
social history should include
-PLOF
-living conditions
-DME
4 questions of pain assessment
-location
-type
-nature
-intensity
TT residual limb length assessment landmarks
medial joint line to end of limb
TF residual limb length assessment landmarks
ischial tuberosity or GT to end of limb
contralateral in tact limb assessment should include
-diabetic foot screen
-sensory testing
-strength/ ROM
-DVT screen
DVT risk factors
-history of thrombosis
-immobilty
-severe infection
-hormone replacement therapy
-surgery
-anesthesia
-critical care admission
-obesity
transtibial key muscles for ROM
hamstrings
hip flexors
contralateral gastroc
transfemoral key muscles for ROM
hip flexors
hip abductors
hip external rotators
lumbar extensors
contralateral LE
is MMT contraindicated in acute setting?
yes if its over the incision. you can do the next proximal joint
transtibial key muscles to strengthen
-quads
-hamstrings
-glute max
-glute med
-abdominals
-UE
transfemoral key muscles to strengthen
-glute max
-glute med
-adductors
-core
-lumbar spine
-pelvic floor
-UE
motions that are super important for transfemoral amputee gait
hip extension, adduction, and pelvic movement
functional status assessment
upper extremity function
aerobic capacity
postural control
sitting/ standing balance
bed mobility
gait
pre-prosthetic phase
time between discharge from acute care and fitting with a definitive prosthesis or until decision is made to not fit with prosthesis
phantom limb pain interventions
-patient education
-compression
-relaxation techniques
-desensitization
-mirror therapy/ VR
-TENS
-heat
-ice
residual limb volume assessment
circumferential measurements over known bony landmarks
a smaller distal circumference allows for less ______ force & better fit during prosthetic use
shear
transtibial ROM key muscles
-hamstrings
-hip flexors
-contralateral gastroc
transfemoral ROM key muscles
-hip flexors
-hip abductors
-hip external rotators
-lumbar extensors
-contralateral LE
Pre prosthetic treatment goals
-minimize comorbidities and post op complications
-independence with residual limb
-HEP
-care of intact LE
-fall prevention
k0
no ability or potential to ambulate or transfer safely with or without assistance; prosthesis does not enhance QOL
K1
able to or potential to use prosthesis for transfers or ambulation on level surfaces at fixed cadence. limited and unlimited household ambulators
k2
ability or potential for ambulation with the ability to transverse low level environmental barriers such as curbs, stairs, or uneven surfaces. limited community ambulator
k3
most common. ability for ambulation with variable cadence. community ambulator who has the ability to transverse most barriers and may engage in vocations, therapeutic, or exercise that demands a prosthesis beyond simple locomotion
k4
ability for prosthetic ambulation that exceeds basic skills, exhibiting high impact, stress, or energy levels. typical of the child, active adult, or athlete
