1
Q
Most common cause of all lower limb amputations
A
Peripheral Vascular Disease (PVD), often related to diabetes.
2
Q
Second most common cause of amputation
A
Trauma, such as from motor vehicle accidents or combat.
3
Q
Amputation through the ankle joint, removing the talus and calcaneus
A
Syme’s Amputation.
4
Q
Amputation through the knee joint
A
Knee Disarticulation.
5
Q
Amputation above the knee, removing the entire lower leg
A
Transfemoral Amputation (AKA).
6
Q
Amputation through the hip joint
A
Hip Disarticulation.
7
Q
Amputation of the entire lower limb and half of the pelvis
A
Hemipelvectomy (or Transpelvic Amputation).
8
Q
Ideal shape of a transfemoral residual limb
A
Conical.
9
Q
Ideal shape of a transtibial residual limb
A
Cylindrical.
10
Q
Common contractures for a transfemoral amputation
A
Hip flexion, abduction, and external rotation.
11
Q
Common contracture for a transtibial amputation
A
Knee flexion contracture.
12
Q
Recommended positioning to prevent transtibial contractures
A
Keeping the knee extended, avoiding prolonged sitting, and using a splint or board.
13
Q
Recommended positioning to prevent transfemoral contractures
A
Regularly lying in a prone position.
14
Q
Sensation that the amputated limb is still present
A
Phantom Limb Sensation.
15
Q
Painful sensations perceived in the amputated limb
A
Phantom Limb Pain.
16
Q
A common, non-invasive treatment for phantom limb pain
A
Mirror Therapy.
17
Q
Post-operative dressing made of plaster or fiberglass
A
Rigid Removable Dressing (RRD) or Immediate Post-Operative Prosthesis (IPOP).
18
Q
Benefit of a rigid dressing over a soft dressing
A
Better edema control, protection from trauma, and prevention of contractures.
19
Q
Technique for applying an elastic wrap for edema control
A
Figure-of-eight pattern with pressure graded from distal to proximal.
20
Q
Elastic sock used to control swelling and shape the residual limb
A
Shrinker.
21
Q
K-Level for no potential to ambulate
A
K-Level 0 (Non-ambulatory).
22
Q
K-Level for a household ambulator
A
K-Level 1.
23
Q
K-Level for a limited community ambulator (curbs, stairs, uneven surfaces)
A
K-Level 2.
24
Q
K-Level for an unlimited community ambulator (variable cadence)
A
K-Level 3.
25
K-Level for high impact, athletic activity
K-Level 4.
26
The 'physician of function' who leads the rehab team
Physiatrist (Physical Medicine and Rehabilitation).
27
Role of the physical therapist in amputation rehab
Mobility, strengthening, balance, and gait training.
28
Role of the occupational therapist in amputation rehab
Activities of Daily Living (ADLs), fine motor skills, and energy conservation.
29
Role of the prosthetist in amputation rehab
Designs, fabricates, and fits the artificial limb (prosthesis).
30
Key goal of the Acute Post-Operative period
Healing, edema control, and pain management.
31
Key goal of the Pre-Prosthetic Training phase
Shaping/shrinking the limb and preventing contractures.
32
Key goal of the Prosthetic Training phase
Donning/doffing, balance, and advanced mobility training.
33
The most important muscle group to strengthen for transfemoral amputees
Hip extensors (Gluteus Maximus).
34
The process of reducing hypersensitivity of the residual limb
Desensitization (e.g., tapping, massage, rubbing with various textures).
35
Surgical procedure where muscles are sutured to opposing muscles over the bone
Myoplasty.
36
Surgical procedure where muscles are anchored to the bone itself
Myodesis.
37
A tangled mass of nerve endings that forms at the end of a severed nerve
Neuroma.
38
A key educational point regarding skin care of the residual limb
Daily inspection with a mirror to check for redness, blisters, or open areas.
39
The condition where a painful stimulus in one area causes pain in the residual limb
Referred Pain or Allodynia.
40
What is a common treatment for verrucous hyperplasia (skin hypertrophy)?
Improve socket fit and/or suspension to reduce distal congestion.
41
What is the term for a patient's self-image and perception of their body after limb loss?
Body Image.
42
The term for an abnormally deep indentation on the residual limb after removing the prosthesis
Girth Reduction or Pressure Indentation (indicating poor suspension or fit).
43
The primary goal of gait training with the first prosthesis
Achieving an even step length and weight bearing symmetry.
44
What condition is the cause of most partial foot amputations?
Diabetes (leading to PVD, ischemia, and infection).
45
A partial foot amputation across the tarsometatarsal joints
Lisfranc Amputation.
46
A partial foot amputation through the midtarsal joint
Chopart Amputation.
47
Why is preservation of the knee joint critical in transtibial amputation?
Better functional outcome; energy expenditure is 40% less than a transfemoral amputation.
48
A common skin issue caused by bacteria in sweat glands in the residual limb
Folliculitis.
49
What is the risk associated with a patient wearing a shrinker incorrectly (too loose proximally)?
Edema (swelling) can be forced to the distal end of the limb.
50
What non-prosthetic mobility aid is typically used in the early stages?
Wheelchair and/or crutches/walker.
51
What is the surgical procedure for closing the wound?
Primary closure or delayed primary closure (if infection risk is high).
52
What is the best position for a transtibial patient to lie in to prevent contractures?
Supine with the knee in full extension.
53
What is the best position for a transfemoral patient to lie in to prevent contractures?
Prone (on stomach) for at least 20 minutes, 2-3 times per day.
54
What does the PT use to measure volume loss and determine prosthetic readiness?
Circumferential measurements of the residual limb.
55
What percentage of lower limb amputations are due to PVD/Diabetes?
Approximately 80-90%.
56
K-Level 2 allows for ambulation across what surfaces?
Low-level environmental barriers (curbs, stairs, uneven ground).
57
K-Level 3 allows for ambulation across what surfaces?
Any environment, independent of distance (unlimited community ambulator).
58
Why is it important to strengthen the hip abductors in an amputee?
To control the frontal plane stability and prevent lateral trunk bending.
59
What should a patient do if a reddened area on the skin does not disappear after 20 minutes?
Do not don the prosthesis and contact the prosthetist/clinician.
60
What complication is a bony overgrowth at the end of the residual limb?
Terminal Spur or Heterotopic Ossification.
61
The soft interface worn directly on the residual limb
Liner (or gel liner).
62
The part of the prosthesis that connects the socket to the foot
Pylon or Shank.
63
Liner with a pin at the bottom is used for what type of suspension?
Locking Pin or Shuttle Lock suspension.
64
Liner with integrated seals is used for what type of suspension?
Suction Suspension (with a one-way valve or active vacuum).
65
Suspension that uses an electric or mechanical pump to create negative pressure
Elevated Vacuum Suspension.
66
Primary biomechanical advantage of Elevated Vacuum suspension
Reduces volume fluctuation, improves proprioception, and reduces pistoning.
67
Older socket design that loads specific pressure-tolerant areas
Patellar Tendon Bearing (PTB) Socket.
68
Modern socket design that distributes pressure over the entire limb surface
Total Surface Bearing (TSB) Socket.
69
A self-suspending transtibial socket design that captures the femoral condyles
Supracondylar-Suprapatellar (SCSP) or Supracondylar (SC).
70
A cuff that goes above the knee and wraps around the thigh for maximum stability and suspension
Supracondylar Cuff.
71
A basic, non-articulating prosthetic foot with a cushioned heel
SACH (Solid Ankle Cushion Heel) Foot.
72
A prosthetic foot with a mechanical ankle joint allowing only dorsiflexion and plantarflexion
Single-Axis Foot.
73
A prosthetic foot that allows motion in multiple planes (DF/PF, inv/ev, rotation)
Multi-Axial Foot.
74
Category of prosthetic feet that store and release energy
Dynamic Response or Energy Storing and Returning (ESAR) feet.
75
Material commonly used in ESAR feet
Carbon fiber.
76
A foot that uses sensors and a microprocessor to control ankle motion
Microprocessor Controlled (MPC) Foot.
77
An MPC foot that also has a motor to provide powered push-off
Powered Microprocessor Foot (e.g., Empower/BiOM).
78
K-Level typically associated with a SACH or Single-Axis foot
K1-K2.
79
K-Level typically associated with a dynamic response (ESAR) foot
K3-K4.
80
Component that allows the user to wear shoes of different heel heights
Adjustable Heel Height Foot.
81
Component added above the foot that absorbs twisting forces
Rotational Torque Adapter.
82
Component that absorbs vertical impact forces
Vertical Shock Pylon.
83
A common prosthetic solution for a great toe amputation
A toe filler and a rocker bottom shoe modification.
84
Primary goal of a prosthesis for a partial foot amputation
Restore foot length, provide a smooth rollover, and protect the residual limb.
85
What does the P in PTB socket stand for?
Patellar (referring to the Patellar Tendon).
86
What is the function of the Single-Axis foot at initial contact?
Rapid plantarflexion to achieve foot flat and quickly stabilize the knee.
87
The Renegade foot (Freedom Innovations) is an example of what general category?
Dynamic Response/ESAR foot.
88
The Tritan Smart Ankle (Ottobock) is an example of what general category?
Microprocessor Controlled (MPC) Ankle/Foot.
89
Disadvantages of MPC Ankle/Feet
Heavy weight, battery controlled, and not very waterproof.
90
What liner material offers the best shock absorption and cushioning?
Urethane (gel).
91
What is the main reason a patient with delicate skin might prefer a Urethane liner?
Better compliance and gentler pressure distribution than silicone.
92
Which liner material is generally the most durable and resistant to friction?
Silicone.
93
What is the clinical indicator that a socket is no longer fitting correctly due to volume change?
Consistent use of 12-15 ply of socks.
94
The foam layer covering the pylon for appearance
Cosmetic cover (or fairing/foamshell).
95
The K-level typically associated with a denial for a Microprocessor foot (by Medicare/insurance)
K1 (Household Ambulation only).
96
What is the purpose of the dorsiflexion stop in a Single-Axis foot?
To limit dorsiflexion and prevent the knee from collapsing (buckling) in late stance.
97
The most common type of pylon used today that is light and adjustable
Endoskeletal (Modular) Pylon.
98
Type of suspension that requires a liner but uses a valve to expel air upon donning
Suction Suspension (simple suction).
99
What is the key goal of fitting an orthosis/prosthesis for a partial foot amputation?
Avoid distal end pressure.
100
An important exercise to maintain for a partial foot amputee
Ankle Dorsiflexion ROM.
101
The socket type for a Syme's Amputation
A Bulbous socket with a medial or posterior window or stovepiping for donning.
102
The relationship between the socket and the prosthetic foot
Prosthetic Alignment.
103
Initial alignment done by the prosthetist in the lab
Bench Alignment.
104
Alignment adjustments made while observing the patient walking
Dynamic Alignment.
105
Typical sagittal alignment of a transtibial socket
Approximately 5-8 degrees of initial flexion.
106
Purpose of setting a transtibial socket in flexion
To facilitate loading on the patellar tendon and prevent genu recurvatum.
107
A force that causes rotation around a joint
Moment.
108
The upward force from the ground that acts on the foot
Ground Reaction Force (GRF).
109
This occurs when the GRF passes behind the knee joint center
A knee flexion moment (causes the knee to buckle).
110
This occurs when the GRF passes in front of the knee joint center
A knee extension moment (stabilizes the knee, but can cause recurvatum).
111
Positioning the prosthetic foot too far posterior results in what moment at the knee?
An excessive knee flexion moment (instability).
112
Positioning the prosthetic foot too far anterior results in what moment at the knee?
An excessive knee extension moment (hyperextension/recurvatum).
113
Typical coronal (frontal) alignment of a transtibial socket
Slight adduction (medial tilt).
114
Purpose of setting a transtibial socket in adduction
To load pressure-tolerant areas (medial tibial flare) and mimic the normal tibiofemoral angle.
115
Placing the foot too far medially (inset) creates what moment at the knee?
A valgus moment (gapping on the medial side of the knee).
116
Placing the foot too far laterally (outset) creates what moment at the knee?
A varus moment (gapping on the lateral side of the knee).
117
An area of the residual limb that is well-suited to handle pressure
Pressure Tolerant Area.
118
Name a pressure tolerant area on a transtibial limb
Patellar ligament, medial tibial flare, anterior and posterior muscle compartments.
119
Name a pressure sensitive area on a transtibial limb
Fibular head, distal tibia, tibial crest, hamstring tendons.
120
The primary purpose of wearing prosthetic socks
To compensate for volume changes in the residual limb and maintain a proper fit.
121
What complaint suggests a patient is wearing too few sock plies?
Pain at the distal end of the limb (bottoming out).
122
What is the term for the limb sinking too deep into the socket?
Bottoming out or Pistoning.
123
What complaint suggests a patient is wearing too many sock plies?
Pain over bony prominences like the fibular head (proximal pressure).
124
Clinical test using clay to check for distal end contact
The Ball of Clay Test.
125
Clinical test using lipstick to identify a specific area of high pressure
The Lipstick Test.
126
If the Ball of Clay test is untouched, what is the likely issue?
Limb is not deep enough in the socket (too many socks).
127
If the Ball of Clay test is flattened, what is the likely issue?
Limb is too deep in the socket (bottoming out, need more socks).
128
What alignment adjustment is needed if the patient exhibits excessive knee extension?
Move the foot posteriorly (or increase socket flexion).
129
What alignment adjustment is needed if the patient is experiencing gapping at the medial proximal brim?
Outset the prosthetic foot (it is too inset).
130
Gait deviation where the trunk bends toward the prosthetic side in midstance
Lateral Trunk Bending.
131
A potential cause for lateral trunk bending
Prosthesis too short, weak hip abductors, or pain on the medial socket wall.
132
Gait deviation with an excessively wide base of support
Abducted Gait.
133
A potential cause for an abducted gait
Prosthesis too long, fear/insecurity, or pain in the groin area.
134
Gait deviation where the prosthetic limb swings out in a circular motion
Circumduction.
135
A potential cause for circumduction
Prosthesis too long, insufficient knee flexion, or inadequate suspension.
136
Gait deviation where the patient rises up on the sound side toes during swing
Vaulting.
137
The primary reason a patient vaults
To create extra clearance for a prosthesis that is too long or does not flex enough.
138
Gait deviation where the heel whips inward at toe-off
Medial Whip.
139
Prosthetic cause for a medial whip
Internal rotation of the prosthetic knee bolt or suspension component.
140
Prosthetic cause for a lateral whip
External rotation of the prosthetic knee bolt or suspension component.
141
Prosthetic cause for excessive knee flexion from initial contact to midstance
Heel cushion is too stiff, foot is set too posterior, or socket is excessively flexed.
142
Prosthetic cause for insufficient knee flexion or genu recurvatum
Heel cushion is too soft, foot is set too anterior, or socket has insufficient flexion.
143
Gait deviation where the body suddenly drops down during late stance
Drop Off.
144
A prosthetic cause for drop off
The prosthetic keel is too short, or the foot is set too posterior.
145
Gait deviation where the prosthetic forefoot slaps the ground at initial contact
Foot Slap.
146
Primary prosthetic solution for Foot Slap at initial contact
Increase the resistance in the prosthetic ankle (adjusting the PF bumper/stop).
147
The preferred pattern for ascending stairs
Lead with the sound limb ('up with the good').
148
The preferred pattern for descending stairs
Lead with the prosthetic limb ('down with the bad').
149
Proper foot placement when descending stairs with an ESAR foot
Place the prosthetic foot with the heel 1/2 to 2/3 off the edge of the step.
150
Gait deviation: Excessive motion of the residual limb inside the socket
Pistoning.
151
Cause of pistoning
Inadequate suspension (e.g., loose pin-lock or poor suction).
152
Gait deviation: A short stance phase on the prosthetic side
Short Prosthetic Step (Antalgic Gait).
153
Cause of a short prosthetic step
Pain in the socket or fear of weight bearing.
154
Key cue to correct an Abducted Gait
Encourage walking with feet closer together, like walking on a painted line.
155
The proper technique for walking on a ramp (incline) with a non-articulating foot
Take shorter steps, lead with the sound limb.
156
The proper technique for walking on a ramp (decline) with a non-articulating foot
Take shorter steps, lead with the prosthetic limb.
157
How should a person with a K2 prosthesis ascend stairs?
Step-to pattern, leading with the sound limb, using a handrail.
158
The primary problem associated with Terminal Impact (slammed extension) in the swing phase
Insufficient swing phase control (e.g., inadequate friction setting in a knee unit).
159
Gait deviation where the foot excessively inverts/everts at initial contact
Mediolateral Instability (or M/L Instability).
160
Prosthetic cause of Mediolateral Instability
Foot inset too much or too little (alignment error) or excessive play in the ankle.
161
The three major requirements for a successful prosthetic step
Foot Clearance, Gait Symmetry, and Balance/Stability.
162
What gait deviation is often a compensatory mechanism for a long prosthesis?
Vaulting or Circumduction.
163
The phase of gait where the prosthetic limb is most likely to experience Drop Off
Terminal Stance.
164
How should a person without a prosthesis safely descend steps?
Backward or by using the "bump up" method (seated).
165
What is the most common cause of Medial/Lateral Whip?
Improper rotation of the socket or suspension mechanism.
166
If a patient has a tight hip flexion contracture, what gait deviation is likely?
Lumbopelvic lordosis (to shift the COG) and a shortened prosthetic stride.
167
What is the key to minimizing energy expenditure when ambulating with a prosthesis?
Achieving a smooth, symmetrical gait pattern.
Amputee Rehab
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