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10 - Rehabilitation > Rehab Exam 3 Review > Flashcards

Rehab Exam 3 Review Flashcards

1
Q

Parts of AFO (4)

A
  • Foundation
  • Ankle Control
  • Foot Control
  • Superstructure
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2
Q

AFO: Foundation

A
  • Basic foundation: Shoe, Plastic (insert) or metal (stirrup) component
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3
Q

AFO: Insert

A
  • Plastic insert or metal insert or foot plate
  • Provides control for foot
  • Helps with donning
  • Lightweight
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4
Q

AFO: Stirrup

A
  • Riveted through shoe shank
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5
Q

AFO: Ankle Control

A
  • Limits DF, PF, or both
  • Solid Ankle- Foot Orthosis: Trim lines anterior to malleoli, controls DF and PF
  • Hinged (articulated) solid-ankle foot orthosis: Metal joint that resists DF and PF; has spring that sets
  • Posterior Leaf Spring: Early stance, pt applies force, upright bends backward slightly; Swing, plastic recoils forward to lift foot
  • DF Assist with Steel Spring (articulated): Coil spring compresses in stance, rebounds during spring
  • PF Resistance: Posterior stop limits PF; prevents PF spasticity
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6
Q

AFO: Ankle Control (Affect on knee position and control)

A
  • Excessive DF = Increased knee flexion and decreased knee stability
  • Excessive PF = Increased knee extension and increased knee stability
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7
Q

AFO: Foot Control

A
  • Medial-Lateral Control
  • Lateral leather strap (pulls ankle to keep from going valgus or varus)
  • Contoured edges
  • Stiffness of material
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8
Q

AFO: Superstructure

A
  • Uprights, shell, band, brim
  • Height provides longer lever arm = increased stability
  • Positioned below fibular head
  • Double metal upright
  • Plastic trim lines narrow or wrapped for stability
  • Spiral AFO: Controls but does not limit motion in all planes
  • Carbon, graphite or titanium uprights
  • Floor reaction control: solid AFO with anterior band near knee which directs forst posteriorly
  • Patellat-tendon-bearing brim
  • Tone-reducing orthosis: decreased spasticity, foot plate and broad upright apply pressure on PF and invertors
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9
Q

Types of locks for KAFO

A
  • Offset joint
  • Drop Ring Lock
  • Pawl lock bail release
  • Knee cap
  • Electronic stance control mechanism
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10
Q

KAFO: Offset Jt

A
  • Pt weight falls anterior to offset jt
  • Hinge placed posterior to jt
  • Adv: Stabilizes knee in ext during stance; Does not interfere with knee flex during swing or sitting
  • Dis: Can disengage during stair climbing or walking on ramps
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11
Q

KAFO: Drop Ring Lock

A
  • In standing, ring drops into place
  • Most common knee control lock
  • Adv: Prevents uprights from bending
  • Dis: Has to be manually disengaged
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12
Q

KAFO: Pawl Lock with Bail Release

A
  • Unlock by pulling on posterior bail
  • Adv: Can by intentionally activated by nudging against a chair
  • Dis: Bulky, Can release unexpectedly against object
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13
Q

WB alignment for using KAFO

A
  • WB must be aligned anterior
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14
Q

HKAFO: Lock used at hip joint

A
  • Metal hinge

- Lock: Drop Lock (more difficult to engage for sitting

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15
Q

Reciprocating Gait Orthosis (RGO)

A
  • THKAFO with hips joined by a metal cable or rod
  • Cable tightens and recoils to propel legs forward
  • Enables patient to have reciprocating gait
  • Components: Offset knee joints (more knee stability, Pre-tibial bands, Solid AFO (more control and support)
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16
Q

RGO Gait

A
  • Shift weight onto RLE
  • Tuck pelvis by extending upper thorax
  • Press on crutches
  • Allow LE to swing through
  • Reverse for next step
  • Very rigid orthoses, holds legs because no control
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17
Q

Purpose of LS Corset

A
  • Increases intra-abdominal pressure
  • Also decreases frontal movement
  • LS Corset is not rigid; no horizontal rigid structure
  • Some corsets have rigid vertical structure (stays) that help keep corset in place
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18
Q

Patient position for wrapping following BKA/AKA

A

BKA (Trans-tibial) - Pt in sitting

AKA (Trans-femoral) - Pt in side-lying

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19
Q

Residual limb wrapping (BKA)

A
  • Elastic bandage/ace wrap
  • Two 4-inch bandages, not sewn together so weave is in contra-position to each other
  • Provides the best compressive forces
  • Wrap in figure 8 to avoid creating tourniquet
  • Fire, even pressure - distal to peoximal
  • Avoid wrinkles and folds
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20
Q

Residual limb wrapping (AKA)

A
  • Elastic bandage/ace wrap
  • Two 6-inch bandages and one 4-inch bandage
  • Two 6-inch bandages may be sewn together, end -to-end, small *not bulky”seam
  • 6-inch bandages applied first, followed by 4-inch bandage
  • Wrap in figure 8 to avoid creating tourniquet
  • Fire, even pressure - distal to peoximal
  • Avoid wrinkles and folds
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21
Q

Shrinkers

A
  • Trans-tibial: Rolled over residual limb to mid-thigh; self-suspending (if heavy thrigh, may require suspension - garters, waist band)
  • Trans-femoral: Incorporates hip spica for suspension
  • Avoid rolling of edges or slipping = tourniquet
22
Q

Height of amputation

A
  • The higher the amputation, the more difficult activities such as stairs and curbs will be
23
Q

Surgical considerations for amputation

A
  • Longest bone length (better for use of prosthesis)
  • Preserve as many jts as possible
  • Vascular supply
  • Skin flap (Fold skin up, or sew at site of amputation)
  • Three skin flaps: Long posterior flap, skew flap, preserve max muscles
24
Q

Purpose of massage s/p amputation

A
  • Increase pliabiity/softness, facilitate scar mobility, shaping of limb, edema control
25
Q

Rigid Dressings

A
  • IPOP (Immediate post-operative prosthesis): plaster-of-paris socket, not adjustable or removable
  • RRD (Rigid removable dressings): Plaster or pre-fab plastic, may be removed for wound inspection
  • Adv: Allows early WB, Reduces edema and pain, Enhances healing
  • Dis: Expensive, application requires special training, must learn to use, limits examination of wound, close supervision during early healing
26
Q

Semi-rigid Dressings

A
  • Unna’s Dressing (gauze has compound of zinc oxide, gelatin, glycerin and calamine - applied in OR); similar to ace wrap, sticks to itself as dressing is wrapped around
  • Adv: Better edema control than soft dressings, promotes better healing than soft dressings, some dressing have impregnated compounds that promote healing
  • Dis: May loosen, not rigid
27
Q

Soft Dressings

A
  • Ace wraps and shrinkers
  • Adv: Inexpensive, lightweight, easily cleaned
  • Dis: Poor edema control; easily slips, can cause tourniquet affect; elastic wrap requires skill to apply
  • Purchasing new shrinkers as edema decreases
  • Cannot use shrinkers until suture/staples removed
28
Q

Requirements for prosthesis (?)

A
  • Length of prosthesis
  • Strength of limb/trunk muscles
  • Skin condition
  • Sensory function
  • Pt ability to learn and retain new information
  • Dimensions of amputation
  • Pt aerobic capacity and endurance
  • Obesity
29
Q

Prosthetic potential

A
  • No general rules/criteria
  • Amb with 1 prosthesis, increased potential for revision
  • Considerations: Cost, energy demands
  • BKA/AKA: Energy, balance, strength
  • BL Amp: Young, agile, strength, coordination, balance, cardio-respiratory
30
Q

Advantages of Syme’s Amputation

A
  • Calcaneal fat pad allows pt ability to WB on end of residual limb
  • Long lever arm = increased prosthetic control
  • Dis: Bulky, bulbous en can cause difficulty with prosthesis
31
Q

Parts of Transtibial prosthesis

A
  • Foot-ankle assembly
  • Shank
  • Socket
  • Suspension
32
Q

Non-Articulated Feet

A
  • Feet and lower shank are one section (no joint)

- SACH, SAFE, Carbon Copy II, Seattle Foot, Flex foot, Springlite foot

33
Q

SACH

A
  • Solid Ankle Cushion Heel
  • Provides small amount of medial-lateral and tranverse motion
  • Several PF angles for different heights; varying heel cusions
  • Absorbs shock, allows PF in early stance
  • Allows hyperextension during late stance
34
Q

SAFE

A
  • Stationary attachment flexible endoskeleton
  • Adv: Provides more medial-lateral ROM in rear foot; Allows amb on uneven terrain
  • Dis: Heavy, more expensive
35
Q

Energy Storing Feet

A
  • SAFE, Carbon Copy II, Seattle Foot, Flex Foot, Springlite Foot
  • Springy sole stores energy
  • Foot bends slightly in early, mid stance, sole stores energy
  • Late stance, weight transfers to opposite LE, foot recoils and returns some stored energy
36
Q

Articulating Feet

A
  • Metal bolt or cable joins foot and lower shank
  • Motion controlled by rubber bumpers
  • Rear bumper = WB on heel causes PF = stable foot flat position
  • Anterior = Anterior to ankle (firm) = DF Stop = resists DF as weight transfers over foot
37
Q

Components of Articulating Feet

A
  • Axes: Single (permits DF, PF, toe break) or multiple (movement in all planes
  • Rotators (absorbs shock in tranverse plane, prevents chafing)
  • Shank (prosthetic “leg” restores length and shape
38
Q

Shank

A
  • Exoskeletal: Wood or rigid plastic (shaped like anatomical leg, can be tinted to match skin tone)
  • Endoskeletal: Aluminum or plastic puylon covered by foam rubber (More natural appearance, can be adjusted for slight angulation)
39
Q

Reliefs (Socket)

A
  • Concavities
  • Pressure relief of sensitive areas
  • Fibular head, tibial crest, tibial condyles, anterior-distal tibia
40
Q

Buildups (Socket)

A
  • Convexities
  • Contact of pressure-tolerant areas
  • Belly of gastroc, patellar tendon, proximal-medial tibia, pes anserinus, tibial and fibular shafts
41
Q

Supracondylar Cuff (Suspension)

A
  • Leather strap above femoral condyles

- Can adjust snugness with straps

42
Q

Fork Strap and Waist Belt (Suspension)

A
  • Add to Supracondylar cuff for more support

- Fork strap attaches anteriorly to prosthesis

43
Q

Rubber Sleeve (Suspension)

A
  • Tubular; covers proximal prosthesis and distal thigh

- Dis: Requires two strong hands, won’t accommodate large tissue in residual limb

44
Q

Distal Attachment (Suspension)

A
  • Silicone sheath and distal pin
  • Sheath clings to skin
  • Pin inserts into receptacle in prosthesis
45
Q

Brim Variants (Suspension)

A
  • Supracondylar suspension

- Supracondylar/Suprapatellar suspension

46
Q

Supracondylar suspension

A
  • Medial/lateral walls extend over femoral epicondyle; plastic wedge inserts into medial wall
  • Adv: Increased M/L stability; Cosmesis of knee; eliminates strap and buckles
  • Dis: Harder to fabricate; expensive
47
Q

Supracondylar/Suprapatellar suspension

A
  • Anterior wall extends over patella

- Dis: High ant wall can interfere with kneeling; Prosthetic knee mroe prominent in sitting

48
Q

Thigh Corset

A
  • Leather or plastic corset attaches to hinges on prosthesis
  • Adv: increased frontal plane stability; increased WB load distribution
  • Dis: Heavier, Increased pistoning; pressure atrophy of thigh; difficult to don laces and velcro
49
Q

Vacuum-assisted

A
  • Pump liner and sleeve creates air-tight environment

- Adv: Decrease edema; regulate edema fluctuation, decrease moisture accumulation; increase proprioception

50
Q

AKA Suction Suspension

A
  • Pressure difference between inside/outsde socket
  • Socket brim fits snugly
  • 1- way air release valve: distal end; residual limb expels air
51
Q

WB occurs where in BKA prosthesis

A

Patellar tendon

52
Q

AKA Socket alignment

A
  • Total contact to distribute load, reduce edema, increase sensory feedback, assist venous return
  • Slight flexion facilitates contraction of hip extensors, decrease lumbar lordosis; facilitates extension for equal step length
  • Pressure tolerate for WB (posterior): glutes, lateral thighs, distal end or residual limb
  • Avoid pubic symphisis, perineum

10 - Rehabilitation (25 decks)

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