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85 Cards in this Set
- Front
- Back
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Before myoelectrics, how was prosthetics driven
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cable driven
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what is myoelectrics
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sensors are attached that tell when the rest of the mm needs to be used
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When was myoelectrics and endoskeletal modular prosthesis used
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Vietnam Vets time period
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what etiologies usually result in amputations
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disease, trauma, tumor, and congenital amputation
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What percentage of patients with amputations have amputations
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>80%
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what diseases/conditions lead to amputations
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diabetes, gangrene and arterial pathologies
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T/F: amputations are done after revascularization has been attempted
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TRUE
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what is the 5 year survival rate for diabetic amputee
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42%
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what is the 5 year survival rate for nondiabetic amputee
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86%
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If a pt is on dialysis what is their prognosis
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"poor"
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what is the most common killer of amputations
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CAD
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what is the % of amputation revision to a higher level within 1 year
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27%
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what is the % of amputation revision to a higher level within 5 year
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61%
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What is the% of contralateral amputation within 1 year
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12%
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What is the% of contralateral amputation within 3 year
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44%
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What is the% of contralateral amputation within 5 years
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53%
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What % of amputations are due to vascular diesase
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70-90%
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what% of amputation surgeries are performed on pts with diabetes with PVD
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>50%
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what % of diabetic and/or vascular amputations could be avoided with proper education and team management approach
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44-86%
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What are 3 things that could significantly decrease risk of amputations
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-Education
-Regular clinic follow up -proper shoe wear |
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T/F: Medicare will pay for prescription shoes for diabetics once a year
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TRUE
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what is degloving?
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a traumatic injury that literally takes the skin off. Amputation occurs because injuries are too severe to try to salvage
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what types of neurological injuries can lead to amputations
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brachial plexus injury so severe that amputation is requried
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what is the average age of a pt with traumatic amputation
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most <45 y/o
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what bone tumors are seen that lead to amputations
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osteogenic sarcoma and Ewing's sarcoma
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What are the implications of dealing with a pt who has a amputation and cancer
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you will have cancer fatigue, immunosupression
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what is congenital amputation
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constriction of developing parts results in amputation
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what is limb deficiency
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malformation that yields a smaller limb
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how are limb deficiencies treated
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with elective amputation
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who performs amputation surgeries
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vascular surgeons, general surgeons, orthopedic surgerons
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what is a skin flap
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preserved skin around where the limb is cut that is used to cover up the area of amputation
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what is myoplasty
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mm to mm attachment
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what is myodesis
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mm to bone
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what is done with nerves during a amputation surgery
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the nerve is pulled down as far as possible and cut. a neuroma can form
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what is done to the vasculature during an ampuation surgery
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the vessels are either sutured or cauterized
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For a transtibial amputation what is done with the fibular head
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is fixed together
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Why is there delayed closure for amputations
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for infection to clear
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what are some special considerations for kids who require amputations
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want to avoid interfering with growth development
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what is the benefit of having a rigid dressing post op
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with compression will help to shape the residual limb
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what is the down side of using rigid dressing post op amputation
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unable to see wound healing
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what is the benefit of using soft dressings
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able to see wounds
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what is the down side of using soft dressing post op amputation
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not as effective for shaping residual limb
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what WB status is seen with IPOP
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limited WB is seen with immediate post-op prosthesis (IPOP)
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what are some complications that can be seen following surgery
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-hematoma
-infection -neuroma -contracture -phantom pain |
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levels of amputation are determined how, with the following etiology:
Trauma |
whatever's viable and clear of infection
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levels of amputation are determined how, with the following etiology:
Tumor |
reset wide margins
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levels of amputation are determined how, with the following etiology:
PVD |
pulse, infection, skin, demarcation, special tests
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what levels of amputation are possible IN THE FOOT
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-Toe
-Ray -Transmetatarsal -Lisfranc -Chopart |
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What is a Lisfranc amputation
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at the tarsal metatarsal
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what is a chopart amputation
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talonavicual and calcaneocuboid
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What is an ankle disarticulation
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AKA symes disarticulation , is where they take the calcaneous and talus. Use the heel flap to walk on. Very function, problem is that socket is huge
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T/F: the longer the residual limb, the more control you have over the prosthesis
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TRUE
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what is rotation plasty
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used with patients who have limb deficiency. in the surgery they resect a part of the femur, and turn the foot so that they are able to use the foot as the knee joint
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What is included in the PT examination for pt with LE amputation:
patient history |
prior level of function
support cormordibities prior amputation goal med |
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what is included in ROS
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-CV system
-pulmonary -cognition/affect -muskulosketeal -sensory -balance -posture |
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what is involved in the Test and Measures for cognitive status for a pt with an amputation
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-orientation
-ability to follow commands -coping strategies -motivation -potential for new learning -problem solving abilities -safety awareness and judgement |
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what is involved in the Test and Measures for range of motion for a pt with an amputation
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-gross UE and trunk assessment
-definitive assessment of bilateral LE: all remaining joints |
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What LE ranges are really important to maintain?
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Knee extension, hip extension.
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what is a good position for pts with amputations to be in
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prone because causes extension, ADduction
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Explain the following for test and measures for pt with amputation: motor status
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functional strength and/orMMT of major mm groups, closed chain mvmnts/eccentric control. overall quality of movement, coordination and timing of movement
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what muscle groups are important to be strong in pts with amputations
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hip extensors and hip abductions
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How do you test sensation for your test and measures for pts with amputations
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sharp/dull, warm/cold, light touch/deep pressure, proprioception. Check that they don't have a stocking-glove, phantom sensations
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what % of pts with amputations experience residual limb pain
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68%
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what % of pts with amputations experience phantom pain
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80%
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what % of pts with amputations experience back pain
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62%
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T/F: pts with a transfemoral amputation tend to have back pain
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100% (according to Julie's experience)
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how does the sitting balance of a pts with amputation change
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superior and posteriorly
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What types of balance do you need to assess for a pt with an amputation
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static,dynamic,supported, unsupported, reactive,anticipatory, sitting, transitional, standing with AD, SLS
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what is associated with ambulation outcome
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SLS, the better balance able to maintain, the better the prognosis
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what do you need to assess for the cardiovascular system for a pt with amputation
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level of endurance in relation to function (W/C propulsion),
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why is it important to look at a pt with amputation CV status
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having a prosthesis for ambualtion requires a high metabolic demand
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What is the VO2 and Velocity difference between a nonamputee and a TTA (trauma)
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increase in VO2 15%, and decrease in velocity 10%
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What is the VO2 and Velocity difference between a nonamputee and a TTA (VASCULAR)
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increase in VO2 30%, decrease in velocity by 30%
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What is the VO2 and Velocity difference between a nonamputee and a TFA(trauma)
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increase in VO2 40%, decrease in velocity by 20%
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What is the VO2 and Velocity difference between a nonamputee and a TFA(vascular)
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increase in VO2 65%, decrease in velocity velocity by 40%
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What is the VO2 and Velocity difference between a nonamputee and a Hip dis/Hemipelc TFA
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increase in 200-300%
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what are things you need to consider with the remaining limb since it is taking extra weight
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-hydration of skin
-patterns of hair loss -skin breakdown -callus patterns -temperature changes across foot, ankle, foot, leg -pulses -joint mobility -orthopedic deformity -current footwear -pt ability to inspect and care for the limb |
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why is common that the residual limb has skin problems
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the limb is accepting more weight regardless of prosthesis, also if the pt has a vascular disease, it would lead to other problems with the skin
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What do you need to pay attention to when considering a prosthesis for a pt with an amputation
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condition of surgical incision,
skin integrity soft tissue mobility length of residual limb shape of residual limb size of residual limb pulses temperature changes |
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The functional mobility aspect of test and measures for pts with amputations
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-transfers
-bed mobility -wheelchair mobility -ambulation with assistive device -ability to manage stairs or other terrain -ability to don and doff -ability to rise from floor |
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The equipment component of test and measures for pts with amputations
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-compression devices
-self care devices -assistive devices and mobility aides -W/C prescription |
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what are some components of pre-prosthetic treatment
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-stretching
-strengthening -balance activities -endurance training -pain management -equipment procedurement |
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What factors do you need to consider when analyzing if a pt is a good candidate for prosthetic
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-medical status
-pre-morbid functional level -mental/cognitive status -body and build type -ROM limitations -support at home -insurance |
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What are the key functional questions you need to ask to determine prosthetic candidacy
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-can you put on your underwear
-able to transfer from bed to W/C -able to walk with crutches |
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what are the members of the prosthetic care team
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-pt and family
-physician -PT -prosthetist -OT -social worker -dietitan -vocational rehab counselor -psychologist -peer mentor |
