S3_L4: Pediatric Limb Deficiency Flashcards
1
Q
Intramembranous ossification is the process of forming _____ by direct differentiation of mesenchymal cells into bone.
A
osteoblasts
2
Q
Endochondral ossification is the process where mesenchymal cells undergo ____ to form cartilage that matures to become bone.
A
chondrogenesis
3
Q
Most commonly occurring type of bone formation or ossification
A
Endochondral ossification
4
Q
This period in pregnancy is crucial for the genesis of limb production
A
first trimester
5
Q
Mesodermal formation of the limb occurs at ____ days of gestation and continues with differentiation until 8 weeks of gestation
A
26
6
Q
A disorder in which affected individuals are born with missing or underdeveloped muscles on one side of the body, resulting in abnormalities that can affect the chest, shoulder, arm, and hand
A
Poland Syndrome
Note: This syndrome is an example of a vascular malformation.
7
Q
A rare condition caused by strands of the amniotic sac that separate and entangle digits, limbs, or other parts of the fetus
A
Amniotic Band Syndrome
Note: This syndrome is an example of a vascular disruption.
8
Q
Upper vs Lower Extremity Prosthetic Acceptance
- Acceptance of prosthesis is variable
- Prosthesis are used more as a mechanical tool
- Generally have high acceptance rates
A. Upper Extremity
B. Lower Extremity
A
- A
- A
- B
9
Q
The highest incidence of malignancy (tumors) occurs between what age range?
A
12-21 years old
10
Q
Absence of a limb (No limb)
A
Amelia
11
Q
Partial absence of a limb (incomplete limb deficiency)
A
Meromelia
12
Q
Meromelia characterized by flipper like appendages attached to the trunk
A
Phocomelia
Note: Phoco means seal (hand attached to shoulder, no arm)
13
Q
Meromelia characterized by absence of half a limb (e.g. half radius/ulna)
A
Hemimelia
14
Q
Meromelia characterized by missing a hand or foot
A
Acheira
15
Q
Meromelia characterized by absence of a metacarpal or metatarsal
A
Adactyly
16
Q
Meromelia characterized by absence of a finger or toe
A
Aphalangia
17
Q
Frantz-O’Rahilly describes this deficiency as complete absence distal to level of loss
A
Transverse terminal deficiency
18
Q
Frantz-O’Rahilly describes this deficiency as unaffected parts do not occur distal to and in line with deficient portion
A
Terminal deficiency
19
Q
Frantz-O’Rahilly describes this deficiency as the absence of central elements with foreshortening of limb
A
Phocomelia intercalary deficiency
20
Q
Frantz-O’Rahilly describes this deficiency as segmental absence of either pre or post-axial elements; intact proximal and distal
A
Paraxial intercalary deficiency
21
Q
Frantz-O’Rahilly describes this deficiency as complete longitudinal absence either in pre or post-axial elements
A
Paraxial terminal deficiency
22
Q
Frantz-O’Rahilly describes this deficiency as intermediate parts are deficient; elements proximal to and distal to deficient portion are present
A
Intercalary deficiency
23
Q
- More complications (e.g., psychological anger, resentment, rejection, etc.) and harder acceptance
- Can achieve (later) functional milestones with or without prosthetic intervention
A. Congenital limb amputation
B. Acquired amputation
A
- B
- A
24
Q
- Difficulty with training patients
- Children with upper extremity limb deficiency adapt and compensates easily with ADLs
- Cause for amputation also affects overall health of child
A. Congenital limb amputation
B. Acquired amputation
A
- B
- A
- B
25
1. Scoliosis is common especially in unilateral limb deficiency
2. Few complications as the baby was born without a limb; they can adapt faster.
A. Congenital limb amputation
B. Acquired amputation
1. A
2. A
26
Timing of fitting UE prosthetics for Congenital Limb Deficiency: Myoelectric device
A. 6 months when sitting independently
B. 12-15 months when ambulatory
C. As young as 1 year old, when able to operate
D. As young as 2 years old
D. As young as 2 years old
27
Timing of fitting UE prosthetics for Congenital Limb Deficiency: Body Powered Prosthesis
A. 6 months when sitting independently
B. 12-15 months when ambulatory
C. As young as 1 year old, when able to operate
D. As young as 2 years old
C. As young as 1 year old, when able to operate
Note: This prosthesis uses the muscles of the UE to control movement of a terminal device
28
Timing of fitting UE prosthetics for Congenital Limb Deficiency: Active Terminal Device
A. 6 months when sitting independently
B. 12-15 months when ambulatory
C. As young as 1 year old, when able to operate
D. As young as 2 years old
B. 12-15 months when ambulatory
29
Timing of fitting UE prosthetics for Congenital Limb Deficiency: Passive Upper Extremity Device
A. 6 months when sitting independently
B. 12-15 months when ambulatory
C. As young as 1 year old, when able to operate
D. As young as 2 years old
A. 6 months when sitting independently
30
Upper limb prosthetic with no moving part/function. It is used for cosmesis and for support for bimanual UE activity.
A. Passive Upper Extremity Device
B. Active Terminal Device
C. Body Powered Prosthesis
D. Myoelectric powered prosthesis
A. Passive Upper Extremity Device
31
Upper limb prosthetic that is characterized by an active hook (prehension like pincer grasp) or hand that can be opened or closed voluntarily, but does not have a dexterity function. It is used for simple tasks or activities, and the other hand is used to control it.
A. Passive Upper Extremity Device
B. Active Terminal Device
C. Body Powered Prosthesis
D. Myoelectric powered prosthesis
B. Active Terminal Device
32
TRUE OR FALSE: For bilateral UE deficiency, UE prostheses are not prescribed as the child will utilize the feet in a natural manner.
True
33
UE prostheses are generally considered at ____ months of age
3 to 6
33
For the use of UE prosthesis, what 2 peripheral nerves are grafted to denervated muscles?
Median and distal radial nerves
34
Preferred age for initial fitting of UE prosthesis
6th month of age (time where sitting balance is achieved)
35
Early prosthetic fitting is designed to:
1. encourage bimanual tasks
2. establish (1)____
3. increase overall independence
4. provide (2)____
5. reduce (3)____
6. Faster acceptance if given early
1. Wearing pattern
2. Symmetrical crawling
3. Stump dependence
Note: Use the prosthesis for transitional movements such as crawling, leaning on the prosthesis for weight bearing. A terminal device is to be used for bimanual activities (legos, stringing beads) then later concentrate on other activities.
36
TRUE OR FALSE: For upper extremity congenital limb deficiency, the goal of early intervention and training revolves around achieving age appropriate milestones.
True
36
Four phase UE amputee protocol of care:
Occurs approximately 8-16 weeks after starting rehabilitation
A. Phase 1: Initial management & protective healing
B. Phase 2: Preprosthetic training
C. Phase 3: Intermediate prosthetic training
D. Phase 4: Advanced prosthetic training
D. Phase 4: Advanced prosthetic training
37
Four phase UE amputee protocol of care:
Goal is to prepare the patient and the residual limb to accept a well-fitted prosthetic socket and functional prosthesis. If wounds prevent socket use, myosite testing/training for myoelectric prostheses occurs.
A. Phase 1: Initial management & protective healing
B. Phase 2: Preprosthetic training
C. Phase 3: Intermediate prosthetic training
D. Phase 4: Advanced prosthetic training
B. Phase 2: Preprosthetic training
38
Four phase UE amputee protocol of care:
Management consists of tolerance to be able to wear prosthesis at least 8 hours a day, integrate prosthesis use in activities, achieve independence in all ADLs, and independently don/doff the prosthesis.
A. Phase 1: Initial management & protective healing
B. Phase 2: Preprosthetic training
C. Phase 3: Intermediate prosthetic training
D. Phase 4: Advanced prosthetic training
C. Phase 3: Intermediate prosthetic training
39
Four phase UE amputee protocol of care:
Management consists of ROM, physical conditioning, desensitization, limb shaping (conical, not spiral), progression in ADLs, and psychologic support.
A. Phase 1: Initial management & protective healing
B. Phase 2: Preprosthetic training
C. Phase 3: Intermediate prosthetic training
D. Phase 4: Advanced prosthetic training
B. Phase 2: Preprosthetic training
40
Four phase UE amputee protocol of care:
Major turning point in the UE amputee’s rehabilitation. The goal is for the patient to master the mechanical actions required for prosthetic limb control.
A. Phase 1: Initial management & protective healing
B. Phase 2: Preprosthetic training
C. Phase 3: Intermediate prosthetic training
D. Phase 4: Advanced prosthetic training
C. Phase 3: Intermediate prosthetic training
41
Four phase UE amputee protocol of care:
Management consists of comprehensive evaluation, wound healing & edema control (with casting or elastic bandage wrapping), pain control, desensitization, scar management, and exercise for flexibility, gross motor activity, psychologic support, and basic ADLs.
A. Phase 1: Initial management & protective healing
B. Phase 2: Preprosthetic training
C. Phase 3: Intermediate prosthetic training
D. Phase 4: Advanced prosthetic training
A. Phase 1: Initial management & protective healing
42
TRUE OR FALSE: Community reintegration is incorporated in every stage of the four phase upper limb amputee protocol of care.
True
43
Four phase UE amputee protocol of care:
Highly individualized phase, the patient should use their prosthesis of choice and goal is to conserve energy, decrease biomechanical stress to the intact limb, decrease extraneous body movements, and decrease use of adaptive equipment.
A. Phase 1: Initial management & protective healing
B. Phase 2: Preprosthetic training
C. Phase 3: Intermediate prosthetic training
D. Phase 4: Advanced prosthetic training
D. Phase 4: Advanced prosthetic training
44
Four phase UE amputee protocol of care:
This phase begins immediately after injury and continues until all the wounds are closed and infection free, and usually lasts for 1-3 weeks.
A. Phase 1: Initial management & protective healing
B. Phase 2: Preprosthetic training
C. Phase 3: Intermediate prosthetic training
D. Phase 4: Advanced prosthetic training
A. Phase 1: Initial management & protective healing
45
Four phase UE amputee protocol of care:
Occurs 2-3 weeks after amputation, and this phase ends with the acquisition of a prosthesis.
A. Phase 1: Initial management & protective healing
B. Phase 2: Preprosthetic training
C. Phase 3: Intermediate prosthetic training
D. Phase 4: Advanced prosthetic training
B. Phase 2: Preprosthetic training
46
Timing of LE prosthesis:
lightweight extension of limb
A. 6 months
B. 9-10 months
C. 2 ½ to 3 years
A. 6 months
47
TRUE OR FALSE: Lower limb deficiency especially above the knee may delay independent achievement of sitting & standing and/or encourage asymmetric sitting posture.
True
Note: The more proximal the limb deficiency, the more likely the delay or asymmetry
48
Timing of LE prosthesis:
prosthesis with weight bearing capacity to allow pull to stand; usually uses monolithic type of prosthesis
A. 6 months
B. 9-10 months
C. 2 ½ to 3 years
B. 9-10 months
49
Timing of LE prosthesis:
lockable knee joint; therapy includes control of knee joint
A. 6 months
B. 9-10 months
C. 2 ½ to 3 years
C. 2 ½ to 3 years
50
3 important characteristics of a LE prosthesis
1. Simple
2. Allow growth adjustment
3. Lightweight to propel
51
Timing of fitting LE prosthetics for Congenital Limb Deficiency: Energy storing-releasing feet
A. Infancy
B. Toddler
C. 2- 3 years old
D. 3-5 years old
B. Toddler
Note: foot can be propelled/rocked using this prosthesis
51
Timing of fitting LE prosthetics for Congenital Limb Deficiency: Knee joint below the knee
A. Infancy
B. Toddler
C. 2- 3 years old
D. 3-5 years old
C. 2- 3 years old
52
TRUE OR FALSE: Goal of early fitting of LE prosthesis is to allow normal two legged standing and provide a means for reciprocating gait development; provide normal appearance.
True
53
Timing of fitting LE prosthetics for Congenital Limb Deficiency: Solid-ankle cushion-heel (SACH) [passive terminal device]
A. Infancy
B. Toddler
C. 2- 3 years old
D. 3-5 years old
A. Infancy
54
Timing of fitting LE prosthetics for Congenital Limb Deficiency: Knee joint above the knee for transfemoral amputation
A. Infancy
B. Toddler
C. 2- 3 years old
D. 3-5 years old
D. 3-5 years old
55
Training and Timing for LE
1. Stand and ambulate with wide base
2. Stand for several seconds on 1 foot
A. 20 months
B. Toddler
C. 2 years old
D. 3 years old
E. 4 years old
F. 5 years old
1. B
2. E
56
Training and Timing for LE
1. Standing on one foot with help
2. Stand on one foot longer
A. 20 months
B. Toddler
C. 2 years old
D. 3 years old
E. 4 years old
F. 5 years old
1. A
2. F
57
Due to the problem of growth, normally LE prostheses are changed annually until (1)___ years, every 2 years between (2)___ and ___ years, then every 3 to 4 years until adulthood.
1. 5
2. 5 and 12
58
Fitting timetable of congenital LE limb deficiency is around ___ months, when the child is ready to pull up to a standing position.
9-10
59
Training and Timing for LE
1. Can stand on one foot momentarily
2. Heel to stride length develops
A. 20 months
B. Toddler
C. 2 years old
D. 3 years old
E. 4 years old
F. 5 years old
1. D
2. C
60
Training and Timing for LE prosthesis
1. Proper positioning
2. Play is the primary motivation for desired movements and activities
3. Goal is to develop normal pattern of gait including stride and step length and velocity
4. Dwell on phantom pain
A. Preprosthetic period
B. Post-amputation period
1. B
2. B
3. A
4. B
61
TRUE OR FALSE: Normally, arm span is almost equal to standing height
True
62
By (1)___ years old, birth height usually doubles and child is approximately 60% of adult height. The child is approximately 80% of final height at (2)___ years old.
1. 5
2. 9
63
Therapy and Training for LE prosthesis
1. Instruct on how to care for prosthesis
2. Focus on addressing information needs of parents
3. Edema control
4. Evaluate good leg for strength (specific exercises done to achieve strength)
A. Preprosthetic period
B. Post-amputation period
1. B
2. A
3. B
4. B
64
During puberty, the standing height increases by approximately ___ cm/month
1
Note: Rate of height and growth increase is not constant and varies with growth spurts.
65
Limb development occurs between ___ to ___ weeks after fertilization.
4 to 8
Note: Most limb defects occur during 4 – 6 weeks.
66
The centers of ossification (endochondral ossification) were derived from ___.
Mesoderm
67
Absence of part or all of an extremity at birth
Congenital skeletal deficiency or limb deficiency / Congenital amputation
68
In children, ____ is the most common cause of (acquired) amputation
Trauma / accidents
69
TRUE OR FALSE: In acquired amputation, lower limb amputation is more common than upper extremity amputation.
True
70
Loss of a limb or part of a limb, the etiology of which may be secondary to trauma, part of treatment, etc. It accounts for 96 to 99% of all limb losses.
Acquired amputation
Note: It is the surgical removal of a limb.
71
Average age range of the prevalence of acquired amputation in children
6-18 years old
72
TRUE OR FALSE: The more distal sites (e.g., toes/fingers) are more commonly affected than the proximal sites in acquired amputation.
True
Note: Toes/fingers comprise 93% of traumatic amputation.
73
TRUE OR FALSE: Acquired amputation commonly affects a single limb and the male than the female population.
True
Note: Affectation on both limbs are rare. The limb affectation depends on dominance (right or left), though right is more commonly affected than the left.
74
Enumerate the 3 types of cancer requiring amputation
1. Osteogenic sarcoma (Bone cancer)
2. Ewing’s sarcoma
3. Rhabdomyosarcoma
75
Surgical Approach for acquired amputation: general principles
1. Preserve (1)___ and ____
2. Perform (2)___ rather than transosseous amputation
3. Preserve (3)___ joint whenever possible
4. Stabilize and normalize (4)___ portions of limb
1. length and growth plates
2. disarticulation
3. knee
4. proximal
76
In the surgical approach principles for acquired amputation, the growth plates must be preserved particularly for children because doing so will preserve the _____ of the child.
growth factor
77
Phantom limb pain (pathologic) is rare in children aged below ____ years old
10
Note: Phantom limb pain is not common in congenital limb deficiency and in children
78
Level of amputation & procedure in UE
1. Wrist disarticulation
2. Phalangeal disarticulation
3. Metacarpophalangeal
A. Disarticulation at the metatarsophalangeal joint
B. Amputation through metacarpal and distal radius-ulna
C. Excision of any part of one or more finger
D. 55 - 90% of the radius/ulna
E. At the proximal radius/ulna and humerus
1. B
2. C
3. A
79
Level of amputation & procedure in UE
1. Below elbow, Long below elbow
2. Short below elbow
3. Medium below elbow
A. 90-100% short above elbow
B. At the proximal radius/ulna and humerus
C. 0-35% of the radius/ulna
D. 35 - 55% of the radius/ulna
E. 55 - 90% of the radius/ulna
1. E
2. C
3. D
80
Level of amputation & procedure in UE
1. Above elbow; long above elbow
2. Standard above elbow
3. Short above elbow
4. Very short above elbow
A. 0-30% of humerus
B. 30 - 50% of humerus
C. 50 - 90% of humerus
D. 90-100% short above elbow
E. At the proximal radius/ulna and humerus
1. D
2. C
3. B
4. A
81
Level of amputation & procedure in UE
1. Shoulder disarticulation
2. Forequarter amputation
3. Elbow disarticulation
A. 0-30% of humerus
B. Removal of part of scapula, clavicle and glenohumeral
C. At the shoulder joint
D. At the proximal radius/ulna and humerus
E. 0-35% of the radius/ulna
1. C
2. B
3. D
82
Level of amputation & procedure in LE
1. Transmetatarsal
2. Partial toe
3. Toe disarticulation
A. Amputation through midsection of all metatarsals
B. Less than 20% of tibial length
C. Excision of any part of one or more toes
D. Disarticulation at the metatarsophalangeal joint
E. Between 20% to 50% of tibial length
1. A
2. C
3. D
83
Level of amputation & procedure in LE
1. Transtibial (below knee)
2. Short transtibial (below knee)
3. Long transtibial (below knee)
A. Amputation through knee joint
B. Less than 20% of tibial length
C. Between 20% to 50% of tibial length
D. More than 50% of tibial length
E. Ankle disarticulation with attachment of heel pad to distal end of tibia
1. C
2. B
3. D
84
Level of amputation & procedure in LE
1. Short transfemoral (above knee)
2. Long transfemoral (above knee)
3. Transfemoral (above knee)
A. Amputation through hip joint
B. Less than 35% of femoral length
C. Between 35% to 60% of femoral length
D. More than 60% of femoral length
E. Amputation through knee joint
1. B
2. D
3. C
85
Level of amputation & procedure in LE
1. Hemicorporectomy
2. Hip disarticulation
3. Hemipelvectomy
A. Amputation through hip joint
B. Amputation through knee joint
C. Amputation of both lower limbs and pelvis below L4 - L5 level
D. Resection of lower half of pelvis
1. C
2. A
3. D
86
Level of amputation & procedure in LE
1. Ankle disarticulation (Syme’s)
2. Knee disarticulation
A. Amputation through hip joint
B. Amputation through knee joint
C. Amputation of both lower limbs and pelvis below L4 - L5 level
D. Resection of lower half of pelvis
E. Ankle disarticulation with attachment of heel pad to distal end of tibia
1. E
2. B
87
Most common complication of an acquired amputation
Terminal overgrowth or spiking at transected end of long bone (diaphyseal)
Note: This may lead to unfit/uncomfortable prosthesis d/t overgrowth in the long run.
88
TRUE OR FALSE: Terminal overgrowth is most common in the humerus, fibula, tibia and then femur.
True
89
The resulting stump should be ____ shaped to fit the prosthesis and there shouldn’t be wounds when placing prosthesis.
cone
90
Most common cause of transverse limb deficiency
Amniotic bands
Note: The degree of deficiency varies based on the location of the band, and typically, there are no other defects or anomalies
91
TRUE OR FALSE: The sensory function of hand is not replaced by prosthesis, thus it is harder to train prosthetic use. Additionally, hand function is complex, making it harder to write with a prosthesis.
True
92
TRUE OR FALSE: The LE prosthesis is more accepted by the user and is rarely removed as it is needed in gait, and mobility demands less precision.
True
93
Most common congenital amputation in the lower extremity
Fibular longitudinal deficiency or fibular hemimelia (No fibula when born)
94
Most common upper extremity congenital limb deficiency
Terminal transradial limb deficiency
95
TRUE OR FALSE: Upper extremity congenital deficiency is more common than that of the lower extremity.
True
Additional: Ratio of 3:1 upper to lower extremity (For UE 1.58/10,000 and for LE .83/10,000)
96
TRUE OR FALSE: 6% of all types of birth defects are limb deficiencies. The incidence is 5 to 9.7 per 10,000 live births.
True
97
Acquired Amputation: Ankle disarticulation, the tibia and fibula are spared, but the rest below are amputated.
A. Syme's amputation
B. Boyd's (Chopart's, Transtarsal)
C. Pirogoff
D. Lisfranc's
A. Syme's amputation
98
Acquired Amputation: The forefoot and talus are removed and calcaneotibial arthrodesis is performed.
A. Syme's amputation
B. Boyd's (Chopart's, Transtarsal)
C. Pirogoff
D. Lisfranc's
C. Pirogoff
98
Acquired Amputation: Calcaneus and tibia are spared to be able to walk
A. Syme's amputation
B. Boyd's (Chopart's, Transtarsal)
C. Pirogoff
D. Lisfranc's
C. Pirogoff
99
Acquired Amputation: Preservation of the calcaneus and heel pad and consequent fixation of the calcaneus to the tibia.
A. Syme's amputation
B. Boyd's (Chopart's, Transtarsal)
C. Pirogoff
D. Lisfranc's
B. Boyd's (Chopart's)
99
Acquired Amputation: Partial foot amputation through the talonavicular and calcaneocuboid joints. The subtalar joint is spared, as well as the talus and calcaneus. The tarsals, navicular, and cuboid are removed.
A. Syme's amputation
B. Boyd's (Chopart's, Transtarsal)
C. Pirogoff
D. Lisfranc's
B. Boyd's (Chopart's)
100
Acquired Amputation: Partial foot amputation through the tarsometatarsal joints (articulations between the bases of the metatarsals and the distal surfaces of the three cuneiforms and the cuboid).
A. Syme's amputation
B. Boyd's (Chopart's, Transtarsal)
C. Pirogoff
D. Lisfranc's
D. Lisfranc's
100
Type of ossification that results in the formation of the axial and appendicular skeleton
Endochondral ossification
101
Type of ossification that results in the formation of the flat bones (skull) and clavicle
Intramembranous ossification
102
Risk factor that increases the risk for digit anomalies
Smoking
Note: During 1st trimester (baby’s fingers are cut)
103
Drug for nausea & vomiting but causes baby limb deficiency
Thalidomide
104
The following are risk factors for congenital limb deficiency, except:
a. maternal diabetes
b. smoking
c. thalidomide
d. valproic acid
e. none of the above
e. none of the above
Note: All maternal ingestions (toxic agent) during 1st trimester must be documented.
104
The following are risk factors for congenital limb deficiency, except:
a. uterine abnormalities
b. maternal occupation (e.g., agricultural)
c. calcium channel blockers
d. none of the above
d. none of the above
105
Center of ossification found in the mid shaft of long bones (e.g., humerus)
Primary center
105
Center of ossification found in the epiphyseal plate. It appears in chondroepiphysis and appears postnatally. It directs formation of bone throughout growth.
Secondary center
106
____ of long bone form the primary centers of growth from which bone lengthens
Chondrocytes
107
TRUE OR FALSE: The secondary ossification centers of the distal femur, proximal tibia, calcaneus, and talus appear at birth.
True
108
The head is disproportionately small at birth; with a ratio of head height to total body height 1:4; at skeletal maturity it changes to 1:7.5. The lower extremity accounts for 15% of length at birth and 30% at skeletal maturity.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false
B. Only the 2nd statement is true
109
The growth plate at end of bones
Physis
109
Part of the long bone that contributes to appositional growth
Perichondral ring
110
Refers to the secondary ossification center in long bones
Epiphysis
111
Refers to the shaft or primary ossification center in long bones
Diaphysis
111
Refers to the area where the bone flares in long bones
Metaphysis
112
TRUE OR FALSE: Congenital limb deficiency is the result of failure of formation of part or all of the limb bud.
True
113
TRUE OR FALSE: Most common cause of congenital limb deficiency is unknown.
True
114
The following are genetically determined syndromes that can cause congenital limb deficiency, except:
a. Thrombocytopenia
b. Holt-Oram syndrome
c. Fanconi syndrome
d. none of the above
d. none of the above
115
Fanconi syndrome is characterized by renal dysfunction and usually presents with the following hand deformities:
1. An underdeveloped, missing, or duplicated (1)___
2. A shortened or missing (2)___
3. A shortened, curved forearm
4. A hand that develops (3)___ to the forearm
5. Impaired movement in the wrist, fingers, and elbow
1. thumb
2. radius
3. perpendicularly
116
A congenital defect where the patient presents with an upper extremity deformity (e.g. congenital amputation) and 65% present with congenital heart defects.
Holt Oram syndrome (hand heart)
Note: Most common area of congenital heart defects is the ventricular septal defect or atrial septal defect
117
TRUE OR FALSE: Aside from the amputation, a child may also present with other congenital problems such as medical problems not related to limb loss (vision, hearing, learning disabilities).
True
Note: Identifying comorbidities such as vision or hearing impairments is important
118
TRUE OR FALSE: Muscle strength (of remaining limbs and muscles crossing those joints) and range of motion (of the joints of the residual limb) are examined with and without the prosthesis.
True
119
Acquired amputation resulting from trauma caused by automobile and motorcycle collisions commonly happens to children ___ y/o and above.
6
120
Acquired amputation resulting from trauma caused by power tools (e.g., lawn mower) commonly happens to children below ___ y/o when unsupervised.
6
121
Neurologic disorders can lead to acquired amputation. Infections from emboli from meningococcemia and pneumococcal septicemia can also cause acquired amputation.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false
C. Both statements are true
122
TRUE OR FALSE: Aside from removing tumors in the musculoskeletal system, amputation is also a form of treatment (e.g., in osteosarcoma).
True
123
Most common etiology for acquired amputation of the UE in adults
Trauma
(followed by tumors)
124
Most common etiology for acquired amputation of the LE in adults
Vascular disease (diabetic [#1], vascular disease, atherosclerosis, immunologic, idiopathic)
Additional: Vascular disease is followed by trauma, then benign or malignant tumors
125
Treatment for the complication of terminal overgrowth or spiking at transected end of long bone
1. distal resection
2. stump capping
126
Acquired amputation complication:
Stump scarring that interferes with weight bearing
A. terminal overgrowth
B. bone spurs
C. phantom sensation
D. phantom limb pain
B. bone spurs
Similar to a callus in the bone d/t friction; may be painful when WB, sharp & causes problems when walking.
127
Acquired amputation complication:
Awareness of missing limb, usually presents with no pain. This sensation is normally felt in the amputated leg usually 1 or 2 months after amputation.
A. terminal overgrowth
B. bone spurs
C. phantom sensation
D. phantom limb pain
C. phantom sensation
Note: Pt thought they still have the limb & feels burning, electric pain
128
Treatment for the complication of bone spurs
Prosthetic modification
129
TRUE OR FALSE: Modalities are used to treat the nerve for pain in phantom limb pain.
True
130
Cognitive assessment for both a typical and developmentally delayed child is critical to prescribing an appropriate prosthetic device and guiding therapy goals. Self care skills should be assessed at a developmentally appropriate level.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false
C. Both statements are true
131
Refers to the subjective assessment of current activity level of the amputee based on self-report and clinical observation
K-Level
132
Level of activity for LE amputation:
The patient has the ability or potential for ambulation with variable cadence. Community ambulator who has the ability to navigate most environmental barriers.
a. K0: Functional Level 0
b. K1: Functional Level 1
c. K2: Functional Level 2
d. K3: Functional Level 3
e. K4: Functional Level 4
d. K3: Functional Level 3
133
Level of activity for LE amputation:
The patient does not have the ability or potential to ambulate or transfer safely with or without assistance, and a prosthesis does not enhance quality of life or mobility.
a. K0: Functional Level 0
b. K1: Functional Level 1
c. K2: Functional Level 2
d. K3: Functional Level 3
e. K4: Functional Level 4
a. K0: Functional Level 0
Note: NO cognitive ability to learn how to use AD, can’t walk/transfer
134
Level of activity for LE amputation:
The patient has the ability or potential for prosthetic ambulation that exceeds basic ambulation skills, exhibiting high impact, stress, or energy levels. (Child, active adult, or athlete.)
a. K0: Functional Level 0
b. K1: Functional Level 1
c. K2: Functional Level 2
d. K3: Functional Level 3
e. K4: Functional Level 4
e. K4: Functional Level 4
Note: Patient can join sports even if amputated
135
Level of activity for LE amputation:
The patient has the ability or potential for ambulation with the ability to traverse low-level environmental barriers, such as curbs, stairs, or uneven surfaces. (Limited community ambulator.)
a. K0: Functional Level 0
b. K1: Functional Level 1
c. K2: Functional Level 2
d. K3: Functional Level 3
e. K4: Functional Level 4
c. K2: Functional Level 2
136
Level of activity for LE amputation:
The patient has the ability or potential to use a prosthesis for transfer or ambulation on level surfaces at fixed cadence. (Limited and unlimited household ambulator.)
a. K0: Functional Level 0
b. K1: Functional Level 1
c. K2: Functional Level 2
d. K3: Functional Level 3
e. K4: Functional Level 4
b. K1: Functional Level 1
Note: Patient can stand/walk within household.
137
More complicated design of UE prosthesis that can be used to perform simple grasp and release is prescribed at ___ to ___ months of age
11 to 13
Note: Take note of patient's attention span, willingness to be handled by therapist
138
Body powered hooks or hands as well as myoelectrically controlled hands are prescribed at around ___ to ___ years old.
1 to 2
Note: For children with congenital conditions, it would be best to prescribe it when the child’s age is <2 yrs old. If the patient if >2 yrs old, is useless since he/she has already adapted to their condition.
139
Term that refers to the metacarpal or metatarsal and corresponding phalanges
Ray
140
TRUE OR FALSE: For acquired amputation due to tumors, it is important to understand whether limb salvage procedures were attempted prior to the amputation.
True
141
Longitudinal deficiencies are named with the bones that are affected, beginning with the most ____ long bone.
proximal
142
TRUE OR FALSE: In classification, the transverse level is named after the segment beyond which there is no skeletal portion.
True
Note: Fraction of the limb in a transverse deficiency is estimated in thirds (upper, middle, lower 1/3), although for carpals/tarsals, metacarpals/metatarsals, and phalanges, these are described as complete or partial.
143
In classification, any bone that was not named is presumed present and of normal form. The affected bone is designated as total or partially absent.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false
C. Both statements are true
144
TRUE OR FALSE: In classification, digit numbering proceeds from the radial or tibial side of the limb.
True
145
The International Society for Prosthetics and Orthotics (ISP) divides all deformities into transverse (no distal remaining portions) or longitudinal (has distal portions). Longitudinal deficiencies describe a partial or complete bone absence.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false
C. Both statements are true
146
Longitudinal deficiencies involve specific maldevelopments (e.g., complete or partial absence of the radius, fibula, or tibia). For longitudinal deficiency, the residual limb is named by the bones that are affected.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false
C. Both statements are true
147
TRUE OR FALSE: Radial ray deficiency is the most common upper-limb deficiency, and hypoplasia of the fibula is the most common lower-limb deficiency.
True
148
Case: 1 y/o patient with presence of ulna, hand, and fingers, although the radius is absent. Provide the classic name of this limb deficiency.
Radial (upper extremity) hemimelia
149
Case: 1 y/o patient with presence of ulna, hand, and fingers, although the radius is absent. Provide the Frantz O' Rahilly name of this limb deficiency.
Intercalary radial deficiency
150
Case: 1 y/o patient with presence of ulna, hand, and fingers, although the radius is absent. Provide the ISPO/ISP name of this limb deficiency.
Longitudinal radial deficiency
151
Case: 6 y/o patient with presence of humerus, hand, and fingers, although the radius and ulna are absent. Provide the classic name of this limb deficiency.
Meromelia
152
Case: 6 y/o patient with presence of humerus, hand, and fingers, although the radius and ulna are absent. Provide the Frantz O' Rahilly name of this limb deficiency.
Intercalary transverse forearm deficiency
153
Case: 6 y/o patient with presence of humerus, hand, and fingers, although the radius and ulna are absent. Provide the ISPO/ISP name of this limb deficiency.
Forearm total elbow disarticulation
154
Case: 4 y/o patient with presence of foot and toes, although the femur, tibia, and fibula are absent. Provide the classic name of this limb deficiency.
lower extremity phocomelia
155
Case: 4 y/o patient with presence of foot and toes, although the femur, tibia, and fibula are absent. Provide the Frantz O' Rahilly name of this limb deficiency.
Intercalary proximal absence of femur, distal absence of tibia and fibula deficiency
(Complete LE phocomelia)
156
Case: 4 y/o patient with presence of foot and toes, although the femur, tibia, and fibula are absent. Provide the ISPO/ISP name of this limb deficiency.
Longitudinal total femur, tibia, fibula deficiency
157
The following are some complications of acquired amputation, except:
a. Heterotopic ossification
b. Dermatologic and skin concerns (wound dehiscence, skin breakdown/ulcers, verrucous hyperplasia, dermatitis, folliculitis, and hyperhidrosis)
c. Joint contractures
d. none of the above
d. none of the above
158
The following are some complications of acquired amputation, except:
a. Pain from overuse syndromes from compensatory techniques, neuroma
b. Psychologically grieving limb loss, depression, body-image concerns, posttraumatic stress disorder
c. Low back pain from altered gait
d. none of the above
d. none of the above
159
Case: 2 y/o patient with absent humerus, radius, ulna, hand, and fingers. Provide the classic name of this limb deficiency.
Upper extremity amelia
160
Case: 2 y/o patient with absent humerus, radius, ulna, hand, and fingers. Provide the Frantz O' Rahilly name of this limb deficiency.
Terminal transverse amelia
161
Case: 8 y/o patient with absent two-thirds of the radius and ulna. The hand and fingers are also absent. Provide the Frantz O' Rahilly name of this limb deficiency.
Terminal radius-ulna deficiency
162
Case: 8 y/o patient with absent two-thirds of the radius and ulna. The hand and fingers are also absent. Provide the ISPO/ISP name of this limb deficiency.
Forearm one-third (or below elbow) deficiency
163
Case: 2 y/o patient with absent humerus, radius, ulna, hand, and fingers. Provide the ISPO/ISP name of this limb deficiency.
Transverse upper arm total deficiency or complete humerus deficiency
