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AHPT 703 Quiz 2 study guide graded A
Removal of part or all of a body part enclosed by skin. - Amputation Most common reason for amputation (70%) - - Peripheral vascular disease (PVD) particularly when associated with smoking and diabetes What are the two reasons for using prosthesis? - Amputation congenital limb deficiencies absence of a hand or foot - Apodia absence of one or more fingers or toes - Aphalangia: flipper limb due to absence of a limb segment - Phocomelia: Amputation Between the 4th and the 5th lumber vertebrae - Hemicorporectomy The loss of any parts of ilium, ischium and pubis - Hemipelvectomy What are the two important characteristic with prosthesis - weight bearing suspension What is good for weight bearing in which the thigh muscles are preserved? - knee disarticulations
Name the advantages of a knee disarticulation - preserve growth in distal femoral epiphysis Name the disadvantages of a knee disarticulation - non cosmetic socket A PVD short transtibial amputee spends more energy for ambulation than: - - PVD standard transtibial
- Traumatic bilateral standard transtibial
- Traumatic unilateral standard transfemoral Advantages of the long posterior flap: - - Well vascularized What are frequently the result of the nerve being cut too long - Symptomatic neuromas What is used in dysvascular transtibial amputations - Long posterior flap muscle stabilization may be achieved by? - myodesis (attachment of muscles to periosteum or bone) Which type of amputation allows for distal weight bearing? - knee disarticulation Ankle disarticulation where the heel pad is kept for weight bearing - Syme's amputation
What areas allows pressure in socket designs - • Patellar tendon (PTB)
- flare of the medial tibial condyle and the ant-medial aspect of the tibial shaft
- Ant-lat aspect of the residual limb
- Midshaft of the fibula
- end of the residual limb (gently) What areas do not allow pressure? - • Anterior and lateral edges of the lateral tibial condyle
- Head and distal end of the fibula
- Crest and tubercle of the tibia
- Anterior distal end of the tibia What socket design Distributes pressures more equally throughout the socket - Total surface bearing What allows for Even pressure, minimal forces, shock absorption and has High cost and weight - Viscoelastic (silicon liner) What type of suspension is sometimes accompanied with medial wedges - Supracondylar system (PTB SC) The more what the more difficult to walk with - Pistoning
Examples of conventional feet - • SACH
- Single axis
- Multiple Axis
- SAFE
- STEN Dynamic response non articulated- long keel - Felx foot Springlite Dynamic response non articulated- short keel - • Seattle
- Carbon copy II Dynamic response articulated - College step true step foot Transtibial Static alignment: In the sagittal plane - Center of the lateral wall to the breast of the heel Transtibial Static alignment: In the frontal plane - IN THE FRONTAL PLANE: - Center of the posterior wall falls 1⁄2" lateral to the center of the heel (maintain enough BOS and transfer weight away from head of fibula) Transtibial Static alignment: slight flexion - - Enhances loading on PT
- Facilitate Quadriceps contraction
- The wound begins gaining strength through epidermal regeneration Maturation phase of healing - May continue for most of first postoperative year
- External factors (e.g. infection, poorly managed edema, poor nutrition, compromised circulation) can delay the process Goals of immediate postoperative care - - Optimal wound healing
- Early preparation of the limb for prosthetic fitting Soft dressing: Gauze, cotton padding and elastic bandage advantages and disadvantages - • Low cost
- Ease of application
- Easy inspection of the wound
- Poor control of edema
- Slippage
- Inadequate trauma protection • Possible tourniquet effect Soft dressing: silicone liners advantages and disadvantages - • Soft cushioning
- Non irritant material
- Difficulty with total weight bearing
- Very hot during summer Soft dressing: semi rigid advantages and disadvantages - - Low cost
- Better edema control
- Minimal pistoning
- Enough support to shape the residual limb
- Need for trained personnel to apply
- Improper application fails to promote blood circulation - Lack of easy access for inspection Soft dressing: rigid advantages and disadvantages - - Excellent shaping of the residual limb
- Less pain and better wound healing
- Better edema control
- Difficult to inspect the residual limb
- Need for highly skilled personnel
- IPOP: Immediate post-operative prosthesis: consists of - a non-removable rigid cast, a simple pylon and basic foot. Main problem with IPOP? - INACCESSIBILITY OF THE RESIDUAL LIMB FOR WOUND INSPECTION What Allows attachment of pylon for earlier ambulation - Removable Rigid Dressing (RRD) Air splint advantages and disadvantages - - Facilitates early ambulation and balance training
Level 2 - Has the ability or potential for ambulation, with the ability to traverse low-level environmental barriers such as curbs, stairs, or uneven surfaces; the limited community ambulator is an example of this level Level 3 - Has the ability or potential for ambulation with variable cadence; typical of the community ambulator who has the ability to transverse most environmental barriers and may have vocational, therapeutic, or exercise activity that demands prosthetic use beyond simple locomotion. Level 4 - Has an ability or potential for prosthetic ambulation that exceeds basic ambulation skills, exhibiting high impact, stress, or energy levels; typical of the prosthetic demands of the child, active adult, or athlete Level 1 qualifies for - Conventional feet such as a SACH or single axis Level 2 qualifies for - Conventional feet such as a multiaxis, SAFE, or STEN Level 3 qualifies for - Dynamic-response feet such as Seattle, Carbon Copy, College Park, Flex Foot, or Springlite Level 4 qualifies for - Dynamic-response feet such as Seattle, Carbon Copy, College Park, Flex Foot, or Springlite Intrinsic pain - Minimal soft tissue
- Vascular spasm
- Neuroma (symptomatic Neuroma results when the nerve is cut too long)
- Referred pain
Extrinsic Pain - Inappropriate prosthetic or orthotic design or fitting
- Common area: Navicular tuberosity, Malleoli, Crest of the tibia, Fibular head Phantom limb sensation - Perception of the absent extremity, tingling, numbness and pressure (feeling that missing leg is still attached and moving Phantom limb pain - Shooting, burning, cramping or crushing in a non-existing limb
