Special Populations Flashcards
1
Q
What is the major cause of bilateral LE loss?
A
Dysvascular disease
2
Q
T/F Rehab is heavily impacted for patients with bilateral LE loss
A
True
3
Q
What is a indicator of successful bilateral success when patient goes from unilateral to bilateral amputee?
A
Successful unilateral prosthetic
4
Q
How does energy expenditure change for bilateral compared to unilateral amputee?
A
Increased energy expenditure
5
Q
Why is there an increased fear of falling for bilateral amputee?
A
- BOS dramatically reduced
- decreased proprioception
- Lack of anterior support
6
Q
What should you emphasize and teach to a bilateral amputee?
A
- transfers and trunk control
2. Teach how to fall and recover
7
Q
Describe the components of a BTT amputee?
A
- Tend to have the same foot/ankle on each limb
- Absorb shock
- Protect the limb
- Suspension
- Decrease pistoning
- Vacuum/suction is preferred
8
Q
Describe the components of a BTF amputee?
A
- RELIABLE stance and swing phase control from the knee unit
- Stability from the ankle/foot (solid ankles)
- Ischial containment socket
- Suction suspension with appropriate liner
- “Stubbies”
9
Q
Rehab considerations for BTT/BTF amputee?
A
Balance Transfers W/C skills Falling & recovery UE Strength Gait
10
Q
Who has better prognosis:
- TF and TT
- BTF
A
- TF and TT
11
Q
For patient with TF and TT, what should you emphasize on the TT side?
A
Strength
Prosthetic components
12
Q
Describe gait for bilateral amputee:
A
- Wide based with decreased speed
- Typically use some AD
- Very taxing
- Community barriers
13
Q
T/F Even if ambulatory ALL B LE amputees need to have proficient WC skills
A
True
14
Q
T/F Bilateral rehab progression is not the same as unilateral.
A
False, Although slower, general progression is still the same
15
Q
T/F Increased likelihood of gait deviations with bilateral amputee
A
True
16
Q
What challenges will pediatric amputee face?
A
Motor development and milestones Learning Psychosocial Skeletal Neuromuscular
17
Q
Describe the components of pediatric amputees:
A
Basic components are the same, but smaller
Durability
Less choice
Age appropriate
18
Q
Accommodating growth and use of prosthetics for pediatrics:
grade school -
Teenagers -
A
grade school - 12-18 months
Teenagers - 18-24 months
19
Q
What is rotationplasty and when is it typically used?
A
- Knee joint is removed, lower leg is turned and attached to femur – ankle now functions as a knee
- Used for tumors of the distal femur or proximal tibia – typically peds
- Prosthetic usually similar to TT
20
Q
Will patient receiving rotationplasty experience phantom limb pain?
A
No, and quick return to function
21
Q
When rehab with pediatric amputee, which is more important, ROM or Strength of patient?
A
ROM > Strength
22
Q
What should you educate parent of pediatric amputee on?
A
Skin care
Device function
Donning/doffing
23
Q
What should a therapist think about when working with pediatric amputee?
A
- Make therapy age appropriate
- Encourage use of prosthesis
- Encourage adaptive sports
- Be realistic
24
Q
What is the goal when working with high-level amputee rehab?
A
allow for participation in physical exercise and/or sports
25
What team responsibilities when working with high-level amputee rehab?
Injury prevention
Motivation
Education
26
When getting high level athlete back to sports, what aspects should therapist consider in regard to patient/residual limb?
1. Acceptable gait – walking and running
2. Stable volume
3. Skin condition
4. Baseline health
5. Reason for amputation
27
Who is a part of the team working with high-level amputee rehab?
1. Patient
2. Coach
3. Prosthetist
4. Strength and Conditioning Coach
5. Physical Therapist
28
What is the role of the prosthetist when working with high-level amputee?
1. Designs prosthetic that is relevant to the increased demand of the amputee athlete
2. Modifies componentry to maximize function and reduce injury risk
3. Frequent communication
29
What is the role of a coach when working with high-level amputee?
1. Must understand muscle function, imbalance, and injury risk concepts
2. Produce a tailored and individualized program
3. Careful monitoring
4. Frequent communication
30
What is the role of a strength and conditioning specialist when working with high-level amputee?
1. Develops optimal conditioning for the specific sport or activity
2. Individualized plan to target all aspects:
- Strength
- Power
- Stability
- Endurance
- Balance
- CV fitness
3. Frequent communication
4. Monitoring
31
As a therapist we would do a basic assessment of a high-level amputee for what purpose?
Seek medical clearance as necessary to determine readiness of amputee
32
As a therapist we would do a readiness assessment of a high-level amputee, which includes what?
1. Gait, CV fitness, core strength, balance, proprioception, muscle imbalances
2. History of previous participation
3. History of previous injury
4. Frequent communication
33
What aspects involved with therapist intervention on basic strength and conditioning for high-level amputee?
UE/LE
Injury prevention
Coordination with CSCS
34
What aspects involved with therapist intervention on core stability for high-level amputee?
Improve power output
Provide for stable base
Sport specific
35
What aspects involved with therapist intervention on gait training for high-level amputee?
Identify deviations
To correct or not correct?
Running assessment
36
For TTA, how is the strength of intact limb in relation to amputated leg?
Less difference in strength between two legs that normal
37
Why might hip musculature be overactive in TTA high-level amputees?
- ↑ energy absorption and generation at the hip of the amputated leg
- Compensates for lack of PF
38
Eccentric ____ power is increased in sound limb while eccentric _____ power was greater in amputated leg of high-level amputees.
Eccentric HS power is increased in sound limb, but eccentric quad power was greater in amputated leg
39
What is the CV impact of amputees?
1. Lower VO2 max than able-bodied individuals (Chin et al 2012)
2. Lower anaerobic thresholds (Chin et al 2012)
40
Describe mechanical overload in regard to amputees?
- Already have non-optimal biomechanics
- Compensatory mechanisms
- Over-reliance on sound limb
41
What is a compensatory mechanisms during normal gait?
Asymmetrical overload of sound limb during normal gait
42
What is a compensatory mechanisms of knee total work for TTA?
Knee total work less on amputated side v. intact side (TTA)
43
What is a compensatory mechanisms for hip energy generation on amputated side?
Increased hip energy generation on amputated side
44
If RL is painful, what happens to all compensatory mechanisms?
All increased
45
Because there is higher energy demand and less muscle to generate force, what happens to recovery time necessary of amputees?
Increased recovery time
46
Overload is dependent of what two factors?
1. Patient
| 2. Amputation level
47
When strengthening amputee, what should be addressed first?
Address compensatory movements through rehabilitation efforts first
48
T/F Strengthening should be sport specific
True
49
T/F Principles of strengthening and endurance training are different than able bodied individuals
False, the same
50
T/F The amputated limb may fatigue faster than the sound limb or the cardiovascular system
true
51
Common to see what compensatory patterns with prosthetic running?
1. Circumduction
| 2. Vaulting
52
Compensatory patterns are worse in what two amputee populations?
TFA and B amputees
53
Why is it difficult to maintain posture during prosthetic running?
due to limb length differences
54
T/F It is more difficult for prosthetic runners to run in straight line versus running corners.
False, OK for straight line running (hard to run corners)
55
T/F It is hard for prosthetic runners to stop.
True, can't control eccentrically
56
What is step 1 of prosthetic running?
Trust the prosthesis
57
What exercises can help facilitate trust of the prosthesis during running?
Develop hip extensor strength
58
What is step 2 of prosthetic running?
- Hip Extension
| - Loads the forefoot of the prosthesis
59
Why do you need adequate hip ext ROM and strength during prosthetic running?
- Need to pull through stance phase
| - Causes speed and power
60
Increase of hip extension will have what effect on contralateral stride length?
Increase contralateral stride length
61
What is step 3 of prosthetic running?
- Stride symmetry
- Focus on creating equal and relaxed strides
- Find appropriate pace
62
Stride symmetry is often easier in what amputee populations?
Bilateral
63
What is step 4 of prosthetic running?
Arm carriage - Add in appropriate arm movements if not already (arms close to body)
64
Describe effect of prosthetic running on start
- ↓ Symmetry during start (not getting energy return at start)
- Acceleration phase requires continuous adaptation by the runner
65
___ (decrease/increase) demand in muscle work in prosthetic sprinting as compared to able bodied sprinters.
Increased
66
____(symmetrical/asymmetrical) stride length, stride time, and impact loads in prosthetic sprinting as compared to able bodied
Asymmetrical
67
____ (decrease/increase) mechanical work on sound limb in prosthetic sprinting as compared to able bodied
Increased
68
_% reduction in force in prosthetic sprinting as compared to able bodied
10%
69
What are the advantages of prosthetic cycling?
- Can be started earlier than running
- May not require specialized prosthesis
- Low impact
- Can allow for balance loss
70
Common modifications for prosthetic cycling?
Pedal systems
Shortened, wider crank arm
Recumbent bikes
71
T/F Because of risk of overload, there must be a balance to avoid considerable setbacks
True
72
T/F Amputee can progress to high-level athletics before finishing "normal" rehab
False, Needs to be finished with “normal” rehab before progressing, have a mature limb
73
T/F Running blades do not increase performance
True
