Amputations and Orthotics

Question 1

What are the four most common causes of UE amputation in order?

Answer 1

1. Trauma
2. Congenital
3. Tumor
4. Disease

Question 2

What are the four most common causes of LE amputation in order?

Answer 2

1. Disease (diabetes, vascular disease, gangrene, infection)
2. Trauma
3. Congenital
4. Tumors

Question 3

What is a neuroma?

Answer 3

A ball of nerves. Can be very painful

Question 4

How does a mirrorbox relieve pain of phantom limb syndrome?

Answer 4

WHen you look into the mirror and see “your limb” there, it can overide the painful feeling in the brain

Question 5

What are three tx. for phantom limb pain, other than mirror box?

Answer 5

1. Graded textures or particles
2. Heat or cold therapy
3. warm water therapy
4. Ultrasound
5. TENS unit
6. Massage
7. Compression or weight bearing
8. Isometric exercises and active muscle movements

Question 6

What is the purpose of using a “Myo-boy”?

Answer 6

It is an assessment and training system for people with UE amputations.
Electrodes are attached to a flexor and extensor
a monitor records muscle signal strength for find the best placement of electodes
the pt. get to practice moving their mucles in the appropriate way.

Question 7

What special considerations are important in prostesis selction and training for people with bilateral amputations?

Answer 7

1. Bilateral amputations should be treated together
2. Mult. disc. team needs to assess psychosocial, equipment and vocational needs of client
3. Foot skills may be more functional
4. Two prosthesis, one harness
5. Learning separation of controls
6. Midline activities (wrist flexion and forearm rotation)

Question 8

Name 4 Pros of body powered prostesis

Answer 8

1. Lower cost
2. No batteries
3. durable
4. lighter weight

Question 9

Name 5 cons of body powered prosthesis

Answer 9

1. Not as good with fine motor
2. Bulky
3. Not the best appearance
4. Overuse of other muscles
5. Need power and ROM to operate

Question 10

Name 7 pros of myoelectronic prosthesis

Answer 10

1. No cables or straps
2. Precise movements
3. More natural movement
4. Can have up to 20-30 lbs of grip
5. Reduces or eliminates harness
6. Looks better
7. Minimal effort to control

Question 11

Name 7 cons of myoelectronic prosthesis

Answer 11

1. Expensive
2. Break down/repair cost
3. Learning curve
4. Battery life
5. Fragile to the elements
6. No proprioceptive feedback
7. Response time can be slow

Question 12

What is the recommended progression for UE amputee wearing schedule?

Answer 12

1. 15-20 minutes 3x per day
2. Increase by 30 mins 3x per day (if no skin problems)
3. By the end of the first week, worn for whole day
4. Bands can increase 1 per day

Question 13

What are the 3. primary elements for Control training?

Answer 13

1. Pt. learns minimal motions to operate with proper body mechanics in mirror
2. Practice drills to learn/review prosthetic components (combine small and simple movements to get large complex functional tasks)
3. Emphasis on assists from environment

Question 14

What are the primary elements of use training?

Answer 14

1. Begins after client understands how to operate and control individual prosthetic components
2. Repetition
3. Gain understanding of how to pre-position, the surrounding objects and how to use environment to help
4. Pre-positioning:Moving prosthetic units in optimal position to grasp an object or perform an activity
5. Prehension: Terminal device control(start with large, hard objects and progress to small, soft and crushable objects)

Question 15

What are the primary elements of functional training?

Answer 15

Applies the concepts of control and use to complete functional and meaningful activities
1.Problem solving approaches

Question 16

List 5 ways to encourage success once a person is fitted for his/her prosthesis

Answer 16

1. A well designed wearing schedule with gradual adjustment period
2. Training in don/doff prosthetic
3. Care of prosthesis
4. Talk about body image
5. Implement a progressive training plan (control, use, functional training)

Question 17

What are the five most common reasons people don’t wear prostetics?

Answer 17

1. Development of one handed ness
2. Poor comfort
3. Lack of sufficient training/skills
4. Maintenance, fitting, appointments too burdensome
5. Unrealistic expectations of outcomes

Question 18

Describe the role of the prosthetist in amputee rehab?

Answer 18

1. Measures, designs, fabricates, fits and services prosthesis
2. Assists in formulation of the prosthesis prescription for the person

Question 19

List 2-3 overuse problems that a person with a unilateral UE amputation may face

Answer 19

1. Fatigue, aching, pain, inflamation, decreased endurance
2. Rotator cuff injuries
3. Elbow: epicondylitis
4. Wrist/forearm: carpal tunnel, tendonitis

Question 20

How is foreign tissue rejection avoided among limb transplant patients?

Answer 20

1. Anti rejection meds

2. Bone marrow transplant(which lowers amount of anti rejection meds and the side effects)

Question 21

On days 0-4 of a finger replantation, what does the OT do?

Answer 21

Keep hand warm, orthosis in “safe position”

Question 22

On days 5-14 of a finger replantation, what does the OT do?

Answer 22

1. Maintain or adjust orothosis to get “safe position”,
2. wound care with non-adhereant dressings
3. Early protected motion via tenodesis effect,
4. teach home exercise program
5. Teach precautions(avoid caffeine or nicotine)

Question 23

On days 14-21 of a finger replantation, what does the OT do?

Answer 23

1. Initiate edema management with light compression
2. Begin place and hold (in intrinsic plus or minus)
3. would care
4. Home excersise program

Question 24

On week 3-4 of a finger replantation, what does the OT do?

Answer 24

1. LIght coban wrap
2. Continue protected A/PROM
3. Scar massage

Question 25

On weeks 5-6 of a finger replantation, what does the OT do?

Answer 25

1. Begin composite wrist and finger flexion/extension 2. Dynamic flexion orthosis if needed 3. night time volar wrist and finger extension orthosis 4. Light functional activity

Question 26

On weeks 4-5 of a finger replantation, what does the OT do?

Answer 26

1. Composite finger flexion with wrist in neutral 2. A/PROM of wrist 3: TENS if poor tendon glide

Question 27

On weeks 6-12 of a finger replantation, what does the OT do?

Answer 27

1. discontinue dorsal blocking splint 2. Progress functional activities 3. add light resistance at 8 weeks 4. Progress strengthening from week 8-12 5. Sensory evaluation

Question 28

On week 12+ of a finger replantation, what does the OT do?

Answer 28

1. WOrk simulation 2. Work conditioning 3. Continue static progressive/dynamic orthotics 4. Sensory eval every 5-6 weeks