Special Populations

Question 1

what is important for bilateral TTA components?

Answer 1

1. tend to have the same foot/ankle on each limb
2. absorbing shock
3. protect the limb
4. suspension
   
   • decrease pistoning
   • vacuum/suction is preferred

Question 2

list some rehab considerations for bilateral TTA

Answer 2

1. gait
2. balance
3. falling
4. W/C and assistive device use, associated transfers
5. UE strength
6. Progress as normal

Question 3

list some considerations for bilateral TFA components

Answer 3

1. need to have reliable stance and swing phase control from the knee unit
2. stability from the ankle/foot
3. ischial containment socket
4. suction suspension with appropriate liner
5. may use Stubbies

Question 4

list some rehab considerations for bilateral TFA

Answer 4

1. Balance
2. transfers
3. W/C skills
4. falling and recovery
5. UE strength
6. gait

Question 5

what are stubbies?

Answer 5

bilateraly TFA sockets with no knee joint only pylons

amputee is very short but these can be really functional

Question 6

T/F: a TFA and a TTA is more functional than bilateral TFA

Answer 6

TRUE

preserve the knee joint

Question 7

list some general gait characteristics for bilateral amputees

Answer 7

1. wide based with decreased speed
2. typically use some AD
3. very taxing
4. community barriers

Question 8

list some main take aways for bilateral LE amputees

Answer 8

1. gait with bilateral prostheses increase energy expenditure
2. even if ambulatory ALL B LE amputees need to have proficient WC skills
3. although slower, general progression is still the same
4. increased likelihood of gait deviations

Question 9

what types of unique challenges do pediatric amputees face?

Answer 9

1. motor development and milestones
2. learning
3. psychosocial
4. skeletal issues
5. neuromuscular issues

Question 10

list some considerations for pediatric amputee components

Answer 10

1. basic components are the same, but smaller
2. durability is an issue
3. less choices available
4. age appropriateness

Question 11

how can a prosthetist account for growth in children, relating to sockets

Answer 11

build the child a socket that is bigger than they need so that they can grow into it

Question 12

what are rotationplasties?

Answer 12

the knee joint is removed, lower leg is turned and attached to the femur - the ankle now functions as the knee

used for tumors of the distal femur or proximal tibia (typically in peds)

Question 13

what is the benefit of a rotationplasty?

Answer 13

no phantom limb

quick return to function

Question 14

list some main takeaways for pediatric amputees

Answer 14

1. rehabilitation:
   
   • ROM > strength
   • AD use
2. educate parents on:
   
   • skin care
   • device function
   • donning/doffing
3. make therapy age appropriate
4. encourage use
5. encourage adaptive sports
6. be realistic

Question 15

what factors/things should be considered for high-level rehab in amputees?

Answer 15

1. acceptable gait - walking and runing
2. stable volume
3. skin condition
4. baseline health
5. reason for amputation

Question 16

list members of the rehab team for high level amputees

Answer 16

1. patient
2. coach
3. prosthetist
4. strength and conditioning coach
5. PT

Question 17

what goes into a readiness assessment conducted by a PT?

Answer 17

1. gait, CV fitness, core strength, balance, proprioception, muscle imbalances
2. history of previous participation
3. history of previous injury
4. frequent communication

Question 18

UE amputations are most commonly caused by _________

Answer 18

industrial accidents or combat injuries

60% of congenital amputations are UE

70% of traumatic amputations are UE

Question 19

list some surgical considerations for UE amputations

Answer 19

1. scar placement not critical
2. levels of amputation:
   
   • wrist disarticulation
   • forearm
     
     • lose pro/sup
     • as distal as possible
   • elbow disarticulation
   • above elbow
     
     • as distal as possible

Question 20

describe the prosthetic fit for UE prosthetics

Answer 20

1. prosthetic arm may be left slightly shorter
2. bony landmarks:
   
   • C7 → harness ring below
   • clavicle → site of breakdown
   • Acromion → to measure length of residuum
   • Scapula → need good mobility

Question 21

describe the below elbow harness system

Answer 21

1. shoulder flex tightens cable and operates terminal device
2. shoulder extension relaxes cable and closes terminal device
3. abduction augments flexion

Question 22

T/F: most amputees prefer prosthetic hands over hooks

Answer 22

FALSE

hook is more functional and durable and the pt can easily see through it (helps compenstate for lack of sensation at the hand)

Question 23

describe how an amputee operates a below elbow harness

Answer 23

they move the scapula or go into shoulder flexion/abduction creates tension on the cable heading to the terminal device which opens the device

Question 24

describe the above elbow harness system

Answer 24

1. main suspension over the deltoid
2. shoulder flexion operates terminal device
3. elbow lock through depression of shoulder with humeral abduction and extension and then operates terminal device
4. elbow must be locked to operate terminal device

Question 25

describe a myoelectric system for UE prosthetics

Answer 25

1. suspended through pin and lock system, suction or supracondylar
2. operated via EMG-like activity
3. electrodes sense muscle contraction to control terminal device
4. flexion closes terminal device
5. if damage to mm or nn in UE can use chest or back muscles to control

Question 26

what is targeted muscle reinnervation?

Answer 26

nerves in residuum are transferred to target mm that no longer perform function. Augments signal to muscle for easier and enhanced prosthetic control

nerves grow into new target tissue

enhances control of myoelectric arm

Question 27

how many surgeries are generally required for osseointegration in UE amputees?

Answer 27

2 surgeries 6 months apart