quiz 1 (1-5) Flashcards
1
Q
prosthesis
A
a device that replaces a missing limb (noun)
2
Q
prostheses
A
plural of prosthesis
3
Q
prosthetic
A
describes a device (adjective)
4
Q
prosthetics
A
the study of or practice of working with prostheses
5
Q
prosthetist
A
a person who practices prosthetics
6
Q
CP
A
certified prosthetist
7
Q
CO
A
certified orthotist
8
Q
CPO
A
certified prosthetist & orthotist
~7500 in US
9
Q
how many people in the US are living with an amputation?
A
> 2 million
10
Q
how many new amputations per year?
A
185,000
11
Q
what is the cause of most LE amputations?
A
vascular disease (82%)
12
Q
what is the cause of most UE amputations?
A
trauma
13
Q
top 4 causes of amputation
A
- diabetes
- trauma
- cancer
- congenital deficiencies
14
Q
clinical signs of peripheral neuropathy
A
-deficits of sensation
-motor impairments
-auto dysfunction
15
Q
4 classic signs & symptoms of PAD
A
- intermittent claudication
- loss of 1 or more LE pulses
- leg numbness
- trophic changes
16
Q
risk factors for PAD
A
smoking, age, diabetes, HTN, heart disease, CVA
17
Q
Leading causes of trauma causing amputation
A
MVA, farming accident, power tools, firearms, burns/ electrocution
18
Q
typical trauma patient profile
A
men 20-29
19
Q
cancer related amputation patient profile
A
osteosarcoma at distal femur, proximal tibia or humerus. male childhood- early adulthood
20
Q
osteosarcoma red flags
A
pain with weightbearing, deep local pain, fractures
21
Q
challenges of congenital deformity
A
rapid growth, cosmesis, provide for function
22
Q
diabetic foot screen risk category 0
A
diabetes but no loss of protective sensation
23
Q
diabetic foot screen risk category 1
A
diabetes, loss of protective sensation in feet
24
Q
diabetic foot screen risk category 2
A
diabetes, loss of protective sensation in feet with high pressure or poor circulation
25
diabetic foot screen risk category 3
diabetes, hx of plantar ulceration or neuropathic fracture
26
foot screen management category 0
follow up yearly
27
foot screen management category 1
follow up 3-6 months
28
foot screen management category 2
follow up 1-3 months
29
foot screen management category 3
follow up 1-12 weeks
30
acute phase
time between surgery and discharge from acute care
31
pre-prosthetic phase
time between discharge from acute care and fitting with a definitive prosthesis or until deciding not to do prosthesis
32
prosthetic phase
long term management includes rehabilitation and training with prosthetic
33
amputation prevention procedures for peripheral arterial disease
-angioplasty/ stenting
-LE bypass graft
34
amputation prevention procedures for osteosarcoma & trauma
limb salvage procedure
35
factors affecting level of amputation
-vascular disease
-postoperative function
-disarticulations
-trauma & malignancy
36
what is myoplasty
attachment of anterior and posterior compartment muscles to each other over the end of the bone. better if you have ischemia
37
what is myodesis
anchoring of muscles to bone. increases stability, muscular control, and proprioception
38
when would equal length anterior/ posterior flap be used?
when conserving bone length or if primary healing is not concerned
39
when would a long posterior flap be used?
when vascularity is of concern or when padding is needed
40
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
41
what is the shortest level of a TTA compatible with knee function
tibial tubercles
42
how much shorter is the fibula from the tibia for limb shaping in a TTA
1 cm
43
historically what was the most common amputation level for people with poor circulation or gangrene?
transfemoral
44
reasons for choosing transfemoral vs transtibial
-trauma
-gangrene spread to the knee
-circulatory status indicating poor chance of healing
45
in a transfemoral amp, the limb is maintained in ________ & ________ during surgery to maintain proper alignment
extension, adduction
46
common issues with transfemoral amp
-hip adductor roll
-hip flexure contracture
-hip abduction contracture
-glute weakness
47
common issue with transtibial amp
knee flexion cotracture
48
contractures can lead to ...
pain, pressure ulcers, further immobility, and functional deficits
49
osseointegration
connection of bone to prosthetic limb. eliminates need for socket, short residual limb, more natural, improved gait, allows normal swelling
50
downsides to osseointegration
-multiple surgeries
-prolonged no ambulation
-risk of fracture
-reduction in high torque activities
-not well known in US
51
hemicorporectomy
below wait amputation, both legs amputated
52
transpelvic
amputation of portion of pelvis and lower extremity
53
hip disarticulation
amputation through hip joint capsule including the entire lower extremity
54
reasons for a knee disarticulation
-inability to provide adequate transtibial amputation secondary to trauma
-knee flexion contracture >45
-congenital deformities
55
reasons for an ankle disarticulation
severe foot trauma
congenital abnormalities
gangrene
56
reasons for a transmetatarsal amp
-infection due to dysvascularity or diabetes
-trauma
57
primary dressing
gauze pads and kerlix
58
secondary dressing
ace wrap, tubing dressing, shrinker
59
mature transtibial residual limb should look like
a tapered cylindrical shape with distal circumference slightly less than proximal circumference
60
mature transfemoral residual limb should look like
more conical shape, with distal circumference slightly less than proximal circumference
61
attention & cognition assessment should not forget to screen for ...
delirium, depression, and fear avoidance
62
social history should include
-PLOF
-living conditions
-DME
63
4 questions of pain assessment
-location
-type
-nature
-intensity
64
TT residual limb length assessment landmarks
medial joint line to end of limb
65
TF residual limb length assessment landmarks
ischial tuberosity or GT to end of limb
66
contralateral in tact limb assessment should include
-diabetic foot screen
-sensory testing
-strength/ ROM
-DVT screen
67
DVT risk factors
-history of thrombosis
-immobilty
-severe infection
-hormone replacement therapy
-surgery
-anesthesia
-critical care admission
-obesity
68
transtibial key muscles for ROM
hamstrings
hip flexors
contralateral gastroc
69
transfemoral key muscles for ROM
hip flexors
hip abductors
hip external rotators
lumbar extensors
contralateral LE
70
is MMT contraindicated in acute setting?
yes if its over the incision. you can do the next proximal joint
71
transtibial key muscles to strengthen
-quads
-hamstrings
-glute max
-glute med
-abdominals
-UE
72
transfemoral key muscles to strengthen
-glute max
-glute med
-adductors
-core
-lumbar spine
-pelvic floor
-UE
73
motions that are super important for transfemoral amputee gait
hip extension, adduction, and pelvic movement
74
functional status assessment
upper extremity function
aerobic capacity
postural control
sitting/ standing balance
bed mobility
gait
75
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
76
phantom limb pain interventions
-patient education
-compression
-relaxation techniques
-desensitization
-mirror therapy/ VR
-TENS
-heat
-ice
77
residual limb volume assessment
circumferential measurements over known bony landmarks
78
a smaller distal circumference allows for less ______ force & better fit during prosthetic use
shear
79
transtibial ROM key muscles
-hamstrings
-hip flexors
-contralateral gastroc
80
transfemoral ROM key muscles
-hip flexors
-hip abductors
-hip external rotators
-lumbar extensors
-contralateral LE
81
Pre prosthetic treatment goals
-minimize comorbidities and post op complications
-independence with residual limb
-HEP
-care of intact LE
-fall prevention
82
k0
no ability or potential to ambulate or transfer safely with or without assistance; prosthesis does not enhance QOL
83
K1
able to or potential to use prosthesis for transfers or ambulation on level surfaces at fixed cadence. limited and unlimited household ambulators
84
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
85
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
86
k4
ability for prosthetic ambulation that exceeds basic skills, exhibiting high impact, stress, or energy levels. typical of the child, active adult, or athlete
