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Amput n Prosthetics
Skills 3 Amputations and Prosthetics SRM
| Question | Answer |
|---|---|
| What are the main causes of amputation | Traumatic injury, Disease-vascular, tumors,infection; Congenital limb deficiencies |
| What is an Acquired amputation | surgical amputation after birth as a result of trauma or disease |
| Terminal Device | Prosthetic hook, hand, or other prehensile device that is inserted into the wrist unit of the prosthesis |
| Transfemoral amputation | across the axis of the femur (AK--above knee) |
| Transhumeral amputation | across axis of humeris (AE--above elbow) |
| Transradial amputation | across axis of the radius & ulna; labeled by the larger of 2 adjacent bones (BE--below elbow) |
| Transtibial amputation | across axis of the fibula & tibia; labeled by larger of 2 bones (BKA--below knee amputation) |
| Most common amputations in 1)children 2)adults | 1)lawnmower 2)farm equip |
| Percentage of congenital UE amputees | 77% transradial left |
| What is the ratio of leg to arm amputations? | 3:1 |
| Primary cause of UE amputation in adults? | Trauma--close to 75% |
| Primary cause of LE amputations over age 60? | Disease--peripheral vascular & diabetes (20% trauma/5% tumors) |
| What changes can be expected with the loss of an upper limb? | Ability to grip, feel, and manipulate objects; physically engage in social interaction; & communicate through gestures; Reactions (body scheme, self-esteem, sense of efficacy). |
| What can OTA do to help new amputee? | 1-give info w/realistic outcomes; 2-introduce to another w/similar amputation; 3-give reference materials for coping, options, org's, etc; 4- communicate w/other team members (psych, spiritual, etc) |
| Who are the core members of the rehab team for amputations? | physician, prosthetist, OT, & PT and patient |
| What team members should only be called in as needed: | social worker, psychologist, & vocational counselor |
| When does the pre-prosthetic program begin | from the post-surgical period until patient receives the permanent prosthesis |
| What does post-operative care address (6 things immediately after surgery) | (JP SEWS):1.Joint mobility 2.pain control 3.Scar prevention 4.Edema reduction 5.Wound care 6. Skin integrity |
| When is phantom limb sensation most common | traumas and hand/fingers more vividly |
| T/F: Phantom limb sensation usually goes away | False- often remains & patient accepts |
| After amputation surgery, provide pat with what 2 things? | stump shrinkers & IPOP (immediate post-op prosthesis) |
| Name 9 goals of pre-prosthetic rehab: | (BAD PRE-PMS)1.Body image 2. ADLs 3.Desensitizing 4.Pat's goals 5.ROM 6.EMG training 7.Prevent scars 8.Muscle strengthening/endurance 9.Stump shrinking/molding |
| Amputations are sometimes performed in order to prevent the spread of infection to a more proximal or systemic level. Name some conditions that may make this necessary: | Gangrene, tuberculosis, Chonic osteomyelitis, immunocompromised, gas producing infection, necrotizing faciitis |
| In 3rd world counties, amputations are sometimes performed in which they divide the radius & ulna bones and the interosseous muscle are used to provide a pincher movement. What is the name of this type of amputation | Krukenberg (also used for Blind bilateral amputee-Preserves sensation) |
| What is the one prosthetic goal | to provid appropriate function to meet each individuals goals & abilities |
| What are the main 2 types of terminal devices | the hook & the hand |
| What are the 2 important terms related to the functioning of a terminal device | VO-Voluntary Opening-hook remains CLOSED until tension is placed on cable and then it OPENS; VC-Voluntary Closing-hook remains OPEN until tension is placed on cable and then it CLOSES |
| In terminal devices, a hand is considered what | a cosmetic device with minimal function |
| How do you determine the most appropriate TD (terminal device) | Based upon pat interests, roles, and preferences (TDs can be interchangeably used with a prosthesis if the shaft size is the same) |
| What are common complications to amputations: | neuromas, skin breakdown, phantom limb syndrome, phantom limb pain, infection, knee flexion contractures |
| Name 6 goals of PRE-prosthetic treatment: | 1.change of dominance activities-if needed 2.ROM of uninvolved joints 3.prepare limb for a prosthesis 4.desensitization 5.Wrapping residual limb to shape & shrink |
| Name 4 goals of prosthetic treatment: | 1.Functional training with prosthesis-Practice occupational roles & engaging activities 2.donning/doffing prosthesis 3.increase prosthetic wearing tolerance. 4.individualize treatment to enhance physical & psychological adjustment |
| What are the 7 goals of LE amputations: | 1.Wrap to shape residual limb/decrease swelling 2. desensitization 3. strengthening UE w/focus on triceps 4. transfer training, stand pivot 5. ADL training; LE dressing most difficult 6. standing tolerance 7. W/C mobility |
| What are good desensitizing techniques so that the residual limb can accommodate touch and pressure in preparation for prosthetics | Weight bearing on residual limb against various surfaces-foam/felt/rice/clay; massage; tapping & rubbing, vibrator; residual limb wrapping |
| What must you address immediately with bilateral amputees | establish some degree of independence to lessen feelings of dependency & frustration (use of feet,chin,knees,teeth; AE for BADLs |
| What age range has the peak occurrences for amputations | 20-49 years old |
| If it is necessary to amputate a child, what will be attempted? | To save the growth plate |
| Define Myodesis | Suture of muscle to bone |
| T/F: the OT contributes to the prescription of the prosthesis | True |
| What is the procedural term for suturing muscles to opposing muscles in amputations | Myoplasty |
| What is the ratio of female to male amputees? | 1:4 |
| T/F: There is a major difference between the occurrence of Left over right UE amputations | False (Unknown) |
| Out of all the amputations due to trauma, what percentage are bilateral? | 10% |
| What is osseointegration? | Osseointegration--(from the Greek "osteon"= bone, and the Latin "integrare"=to make whole).The term refers to the direct structural and functional connection between living bone & the surface of a load-bearing artificial implant(prosthetics for amputees) |
| More commonly performed in Europe, what 2 things should you know about osseointegration? | Can be used with myoelectrics AND Maximize existing ROM |
| What are 2 severe complications with osseointegration? | infection at attachment sight AND Oozing of internal fluid |
| What Peripheral Vascular Disease Risk Factors are common causes of amputations: | Smoking High blood pressure High cholesterol Diabetes Obesity |
| What are the 4 types of Aquired amputations? | 1.Trans –across the long axis of a long bone 2.Disarticulation –between bones 3.Partial – of the hand distal to the wrist joint 4.Exception – Forequarter – scapulo-thoracic and sternoclavicular joints |
| How do we evaluate patient for prosthetics | Strength and ROM Medical History Myo Testing (then options & formulate plan) |
| Wrist prosthesis: | Flexion Disconnect Constant Friction Combination Laminating Ring |
| Micro-processor Controlled: | Battery Powered Myo-electric or Switch Controled Myo uses EMG signal to switch and signal functions |
| What are the benefits of a cable operated prosthesis? | PRICED:1.Proprioception thru harness system 2.Reduced weight & maintain cost 3.Increased excursion velocity (mvmt speed) 4.cost 5.enviro resistive 6.durable construction |
| What are the limitations of a cable operated prosthesis? (FUCA GAP) | Funct. ROM; Uncomfortable harness-restricts; Cosmesis poor for static & dynamic; Axilla Anchor-NES; Grip/Pinch strength; Atrophy intrinsics in encapsulated limb; Poor coordination between prosthetic & normal NM movement; |
| In addressing psychosocial issues pertaining to prosthetic adjustment time: _____prosthetic use helps to minimize grief, within ____ days is considered best. | Early; 30 (aka golden period) |
| When do you fit for prosthesis? | Depends upon skin condition, scar tissue (do asap) |
| What are some movements used to control cable prosthetics? (5) | G/H Flexion, Glenohumeral (g/h) ABduction, Bi-Scapular ABduction, Shoulder depression, Chest expansion |
| Gleno-humeral Flexion movements provide: | Excellent Force Excellent Excursion Main Work Source Can be Conspicuous |
| Chest expansion movements provide: | Moderate Strength Poor Excursion Inconspicuous Movement Alternative Locking Motion |
| Shoulder Depression movements provide: | Moderate Force Moderate Excursion Elbow Lock |
| (Bi)Scapular Abduction movements provide: | Excellent Strength Poor Excursion Assistive Movement Activities at Midline |
| Gleno-humeral Abduction movements provide: | Excellent Force Obvious Movement Not Easy to Harness Assistive in Elbow Lock |
| What types of grasps are achievable with a hook? | Hook Cylindrical Fist Spherical Tip Palmer prehension (3 jaw chuck) Lateral prehension |
| Most important part of any prosthetic design | The interface for socket! provides link between pat & prosthesis (comfort/flexible) |
Created by:
RadGirl13
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