1
Q
Soft Dressings consist of:
A
- gauze, cotton padding and an elastic bandage
- most commonly used dressing postoperatively
- (ACE Bandage/Wrapping and/or Shrinker)
2
Q
Soft dressing advantages:
A
*
3
Q
Types of Dressings (3)
A
- Soft
- Semi-Rigid
- Rigid
4
Q
Types of Rigid Dressings
A
- Immediate postoperative prosthesis
- Rigid Removable Dressing
- (Plaster of Paris)
5
Q
Types of Semi-Rigid Dressings
A
- Unna Boot
- Air Splint/Pneumatic Post Amputation Mobility Aid (PPAM)
6
Q
Phantom Pain Treatment options:
A
- Manual Therapy
- e.g. Tapotement
- Electrical Modalities
- e.g. TENS
- Electroconvulsive Therapy
- Stress management and voluntary muscle relaxation
- biofeedback
- Ultrasound
7
Q
4 Types of exercise:
A
- Positioning
- Flexibility
- Desensitization Activities
- Strengthening
8
Q
Pressure relief techniques days 1 - 10
A
- ADL’s
- Bed Mobility Skills
- Transfer training
9
Q
Knee Types
A
- Polycentric
- Single Axis
10
Q
Types of Friction for knees:
A
- Mechanical
- Pneumatic
- Hydraulic
- Modular Ergonomically Balanced Stride Polycentric
11
Q
Knee Braking or Locking Mechanisms
A
- Stance control knee
- micrprocessor control
12
Q
IPOP Advantages
A
- control and shaping of residual limb
- protection of the surgical site
- improved healing time
- maintenance of residual and sound limb and upper body strength
- reduction of contracture development
- maintenance of cardiovascular status
- early return to balance and ambulation
- social and emotional benefits
- shorter hospital stay
- shorter overall recovery time
- quicker identification of patient functional levels
13
Q
IPOP Disadvantages
A
- impaired healing
- lack of easy inspection of the incision site
- falls or injury due to early ambulation
14
Q
IPOP Contraindications
A
- Hx of slow healing
- Extreme obesity
- Excessive pre-operative edema
- Lack of 45 days of preoperative ambulation
15
Q
Benefits of patellar tendon bearing socket:
A
- offers areas of pressure and areas of relief
16
Q
Indications for a hydraulic knee unit:
A
- Walk at varying cadences
- Walk on uneven ground
- Patient unhappy with cadence response or lack of stability in mechanical friction knees
- Take small steps in their occupation
17
Q
Disadvantages of a hydraulic knee unit (2):
A
- Increased expense
- Increased weight
18
Q
Indication and Benefits of traditional suction suspensions:
A
Indication:
- Most patients with stable volume residual limbs
Benefits:
- Increased comfort and cosmetic appearance
- Increased proprioception
- Decreased piston action
19
Q
Disadvantages of traditional suction suspension:
A
- Fitting may be difficult
- especially in the presence of scarring, volume changes, or weight changes
- May be unsuitable for individuals with balance problems, upper limb deficiencies, strength problems, or cardiovascular problems due to amount of effort required for application
- Perspiration problems may cause development of rashes
20
Q
Indication and benefit of roll on suction:
A
Indication:
- Those who cannot apply digital suction
Benefits:
- (Same as traditional suction)
- Increased comfort and cosmetic appearance
- Increased proprioception
- Decreased piston action
21
Q
Disadvantages of roll on suction:
A
- Same as traditional suction
- Also
- not as durable
- Excessive perspiration and heat
- May not fit all sizes
22
Q
Five types of conventional foot-ankle assemblies:
A
- Single axis foot
- internal keel, molder rubber shell, metal single axis joint, PF/DF bumpers
- Multiple axis foot
- offers inversion, eversion and rotation
- good for hikers, golfers and those with brittle skin
- Solid ankle cushioned heel (SACH):
- one of the most common assemblies
- good general use foot
- no propulsion at terminal stance
- Stationary attachment Flexible endoskeletal
- Accomodates to uneven surfaces
- Stored Energy Foot
- keel compresses in the loading response of gait and stores energy
- offers smooth stance roll over
- allows a lot of motion and accomodates numerous shoe styles
23
Q
Hydraulic vs. Mechanical knee friction
A
- Mechanical:
- Uniform resistance provided by constant friction
- adjustable to the wearer’s cadence (but not responsive to changes in cadence)
- durable and inexpensive
- no stance stability
- Too rapid of gait results in vaulting or excessive heel rise
- Rarely used unless patient is in remote area with limited access to prosthetist
- Hydraulic:
- Allow ambulation at any speed
- resistance compensates for speed
24
Q
Areas of weight bearing in a PTB socket:
A
- Patellar tendon
- Flare of the medial tibial condyle and the anteromedial aspect of the tibial shaft
- Anterolateral aspect of the of the residual limb
- midshaft of the fibula
- Gentle end bearing as tolerated
25
Areas of relief in a PTB socket:
* 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
26
Upper extremity hand grips (5):
* _Precision_ (pinch)
* To pinch a small object
* Thread needle, grain of rice
* _Tripod_ (pinch)
* 3-jaw chuck
* _Lateral_
* Turning a key in a lock
* _Power hook_
* Carrying a briefcase by the handle
* _Spherical_
* Screwing in a light bulb, opening a doorknob
27
Steps of falling:
* Attempt to throw weight toward the sound side by bending at the waist
* Break the fall, if possible, with the hands
* Roll onto the sound side
28
What causes medial (or **lateral**) whip for transfemoral amputation?
* Faulty socket contours
* Knee bolt externally (or **internally**) rotated
* Foot malrotated
* Prosthesis donned in malrotation
* With sliding friction unit, fast pace
* *Per text: muscle weakness of the residual limb can result in rotation of the soft tissue and prosthesis over underlying bone (whip at toe-off)*
29
Why would a transtibial patient exhibit excessive ipsilateral knee flexion when transitioning from Initial contact to weight acceptance (heel)?
* High shoe heel
* Stiff heel cushion
* Socket too far anterior
* Foot too far posterior
30
What commonly causes a circumducted gait for a transfemoral amputee?
* Socket too small
* or limb too big
* Extension aid is too tight
* Excessive friction in the knee
* Plantarflexed foot
* Loose suspension may cause pistoning
* Also
* hip abduction contracture
* habitual circumduction due to fear of stubbing the toe
* residual limb discomfort
31
What knee prosthetic is best for knee disarticulation?
* A knee disarticulation prosthesis
* Flexible liner and flexible suction socket are recommended
* Polycentric knee is often used with knee disarticulation prosthesis
32
Increased cadence with mechanical friction in single axis knee results in:
* Vaulting or excessive heel rise
33
UE Prosthetic Socket should be:
* Total Contact
34
Why would a patient choose not to wear an UE prosthetic device?
1. Comfort
2. Proprioception
3. Mobility
4. Poor experience
5. Finances/Insurance
6. Not functional
7. Unaware of options
35
A component that would limit hip flexion and assist knee flexion with a transpelvic prosthetic device:
* Stride-length-control strap
36
Wrist Units
1. Quick disconnect
2. Locking
3. Wrist flexion
37
Impinges on the abdomen or ASIS if too high
* Quadrilateral Socket (Anterior Wall)
38
Quadrilateral Socket (Lateral Wall)
* Must provide adequate lateral support to the femur in midstance to prevent a Trendelenburg sign as the contralateral side is in swing.
39
Quadrilateral Socket (Posterior Wall)
* Provides weight bearing surface for the ischial tuberosity
40
Quadrilateral Socket (Medial Wall)
* The height is the same as the posterior wall to prevent adductor roll
41
Weight bearing in a Quadrilateral Socket
* Ischial tuberosity and Gluteal Muscles
42
If one residual limb is longer than the other in a bilateral LE amputation, the process for ascending steps or ramps is:
* Steps
* Longer residual limb should ascend steps first
* shorter residual limb should descend the stairs first
* Ramps (front or side approach)
* require a great deal of hip flexion
* Longer residual limb should ascend steps first
* shorter residual limb should descend the stairs first
43
Wearing schedule:
* Days 1-2:
* 1/2 hour in both AM and PM. Allow some ambulation and monitor fit.
* Days 3-4:
* Increase to 1 hour in both AM and PM.
* Days 5-10: Increase to 2 hours AM and PM wearing time.
* Days 11-14: All AM, then remove and check before lunch. All afternoon then remove and check before dinner. Up until bedtime.
* Days 14+: Full time wear. Skin and fit checks at least once daily.
44
An ideal candidate for a polycentric axis knee is:
* patient with a knee disarticulation amputation
* Also patients with:
* short transfemoral amputations
* weak hip extensors
45
Static alignment for the transtibial prosthesis in the:
* frontal plane:
* sagittal plane:
* Frontal plane:
* from the center of the posterior wall of the socket to about 1/2 inch lateral to the center of the heel
* Sagittal plane:
* from the center of the lateral wall of the socket to the breast of the heel
46
Placement of the foot too medial to the socket causes:
* Lateral thrust [rotation of the socket] that places pressure on proximal medial residual limb and distal lateral residual limb.
47
Transtibial prosthesis placement too far lateral to the socket:
* causes medial thrust
* places pressure on the fibular head of the residual limb and distal medial limb
48
Purpose of the quadrilateral socket:
* Medial wall:
* contains tissues medially and provides couterpressure to the lateral wall
* prevents adductor roll (medial wall is same height as posterior wall)
* Lateral wall:
* provides lateral support to the femur in midstance to prevent trendelenburg as the unamputated side is in swing
* Anterior wall:
* Blocks forward motion of the residual limb
* Posterior wall:
* provides a weight bearing surface for the ischial tuberosity
49
Weight bearing in a quadrilateral socket is primarily through:
* The ischial tuberosity and the gluteal muscles
50
Landmarks used to determine fit for quadraliteral socket:
* fit of the adductor longus tendon
* the ischial tuberosity should fit 1/2 inch behind the inner surface of the ischial shelf and 3/4 to one inch lateral to the inner surface of the medial wall
51
Which suspension system is least likely for a person with a short transtibial amputation?
* Supracondylar cuff
52
In order to increase stability of the knee, how is the knee ususally aligned with regard to the TKA line?
* Posterior to the TKA line
* ?!A knee set too far anterior to the TKA line will have excessive stability and be difficult to flex?!
53
What prosthetic feet are especially suitable for elderly patients? Why?
* Elderly patients classified as K1, with limited mobility (household ambulation) qualify for a solid ankle cushion heel (SACH) foot or a single-axis foot. These components are adequate for household ambula- tion, relatively lightweight, mechanically simple, and relatively inexpensive.
54
For the patient with a very short amputation limb, which socket?
* supracondylar/suprapatellar brim suspension is indicated, as well as an elastic sleeve and a thigh corset.
55
How is the wearer of a hip disarticulation prosthesis prevented from inadvertently flexing the pros- thetic hip and knee?
* The axis of the hip joint of a hip disarticulation prosthesis is anterior to the acetabulum, thus placing the weight line of the torso posterior to the mechanical joint, preventing inadvertent hip flexion. The axis of the knee joint is placed posterior to the wearer’s weight line, stabilizing the prosthetic knee.
