Equipment, IER, NPTE, Physical therapy
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| What muscles should be strengthened if long term ambulatory aids are to be used | shoulder depressors including lower trap, pectoralis major and latissimus dorsi
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| Three point gait | both assistive devices and the involved leg are advanced together then the uninvolved leg
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| two-point gait | one assistive device and the opposite extremity move together followed by the other assistive device and extremity
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| Four point gait | slow gait pattern one assistive device advances forward and placed on floor then advancement of opposite leg repeat for the other side- maximum stability
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| swing to gait | assistive devices are advanced forward together then the legs are swung forward to meet the assistive devices
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| swing through gait | assistive devices are advanced forward together then the legs are swung forward beyond the assistive device-not as safe as swing to and can only be done using crutches
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| Which assistive devices can be used for stair ascending/descending | crutches or small based canes
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| When in a wheelchair when are pressure relief push ups done | every 15-20 minutes or 3-4 times per hour
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| When are elevating leg rest contraindicated | patients with knee flexor hypertonicity
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| When is a tilt in space wheelchair indicated | for patients with trunk extensor spasms or pressure relief
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| When using a Body Weight Support System(BWS) without a treadmill what is the initial % of weight supported | 40% body weight progression is to decrease by 10% increments until there is no support BWS>55% is contraindicated as it interferes with achieving foot flat during stepping
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| Three-point principle with orthotics | single force is placed at the area of deformity or angulation with two additional counter forces applied in opposite direction above and below the deformity
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| Heel insert FO | heel spurs and plantar fasciitis
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| Scaphoid pad FO | supports longitudinal arch used for pes plantus-flatfoot
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| Semirigid plastic insert FO | applies medial or lateral force to calcaneus used for subtalar (rear foot) eversion or inversion abnormalities
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| Metatarsal pad FO | takes pressure off metatarsal heads used for metatarsalgia (metatarsal pain)
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| Metatarsal Bar FO | flat strip of leather or plastic placed posterior to the metatarsal heads used for metatarsalgia (metatarsal pain)
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| Thomas or medial heel wedge FO | used for pronation and flexible pes valgus (flat foot-arch is present when non-weight bearing and gone when weight bearing)
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| Lateral heel wedge FO | used for excessive pes varus (supination) or genu varum (bow legged)
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| Medial/Lateral SOLE wedges FO | used for fixed lateral forefoot valgus or varus problems
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| Rocker bar FO | builds up soles allows more push off in weak or inflexible feet used for metatarsalgia and with weak plantarflexion
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| Solid AFO | limits all foot and ankle motion used for severe pain or instability
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| Metal posterior stop AFO | limits plantarflexion used to correct for knee recurvatum in stance and toe drag during swing phase of gait
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| Metal anterior stop AFO | limits dorsiflexion used to prevent knee buckling or excessive knee flexion during early stance
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| Posterior leaf spring AFO | dorsiflexion assistance from a plastic insert that lifts the foot during swing phase used for weak dorsiflexors
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| Dorsiflexion spring assist AFO | not appropriate if spasticity is a factor
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| What does a valgus correction strap do | it is attached to the medial portion of shoe exerting a lateral force to restrain pronation it controls the subtalar or rear foot
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| What does a varus correction strap do | it is attached to the lateral portion of the shoe exerting a medial force restraining supination or the rear foot
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| Which type of AFO molded or conventional allows for volume change of the lower leg | conventional AFO
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| Offset joints in KAFO | hinge is placed posterior to the midline of the leg assists in knee extension contraindicated with knee flexion contractures
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| Drop ring lock KAFO | MOST COMMON KNEE CONTROL locks the knee in extension
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| Craig-Scott KAFO | commonly used for individuals with papraplegia (T9-12 lesions)
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| Reciprocating gait orthosis (RGO) THKAFO | used for patients with T9-12 level of spinal cord lesion or spina bifida lesion usually with children
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| ParaWalker THKAFO | limit hip flexion and resist hip ABD/ADD used for patients with lower throracic spinal cord lesions
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| Toronto hip/Scottish Rite HO | used for Legg-Calve' Perthes disease (avascular necrosis of the hip) affected hip is held in ABD and IR
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| scoliosis orthoses | used to prevent the lateral curve from increasing
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| milwalkee orthoses- scoliosis | used for scoliotic curves of 40 degrees or less
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| Boston orthoses-scoliosis | can be worn under clothes used for scoliotic curves of 40 degrees or less to treat spondylolisthesis (anterior slip) and conditions of severe trunk weakness
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| At what level would a wrist driven tenodesis orthosis be used | facilitates tenodesis grasp in patients with quadraplegia at C6 level
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| Transmetatarsal amputation | through the midsection of all metatarsals
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| Syme's amputation | ankle disarticulation with attachment of the heel pad to the distal end of the tibia for weight bearing
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| Transtibial (Below the knee) amputation | long BTK more than 50% of tibia is left
standard BTK 20-50% tibia is left
short BTK less than 20 % is left
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| Knee disarticulation | amputation through the knee with the femur intact
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| Transfemoral (Above the knee) amputation | long AKA more than 60% of femur is left
ideal AKA 35-60% of femur
short AKA less than 35% of femur left
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| Hip disarticulation | amputation through the hip jt pelvis intact
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| Hemipelvectomy | resection of the lower half of the pelvis
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| Hemicorporectomy | amputation of both lower limbs and the pelvis below the L-4, L-5 level
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| Wrist disarticulation | amputation through the wrist jt
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| Transradial | Below the Elbow (BE) amputation
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| Elbow disarticulation | amputation through the elbow
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| Transhumeral | Above elbow (AE) amputation
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| Shoulder disarticulation | amputation through the shoulder
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| Post-op amputation dressing- ridgid | immediate limits residual limb edema
does not allow for daily wound inspection and dressing changes
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| post-op amputation dressing - soft | inexpensive
elastic wrap and elastic shrinker
poor control of edema
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| post-op temp prosthesis | can be fitted as soon as the wound is healed
shrinks residual limb more effectively
allows for early ambulation
normally used for younger candidates whose amputation was not a result of vascular disease
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| What are the components of a prosthetic | socket and terminal device
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| prosthetic socket | custom molded to the residual limb with total contact and full load distribution with the goals of assisting circulation and providing maximum sensory feedback
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| prosthetic sock | provide soft interface between the residual limb and socket
used to accommodate for changing residual limb volume
should not exceed 15 ply thickness for proper fit and weight bearing of the socket
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| prosthetic terminal device | functions to provide an interface between the prosthesis and the external environment
for LE prosthesis it is the foot
for UE prosthesis it is the hook/hand
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| partial foot prostheses | needed more for transmetatarsal amputation
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| what does a Below-Knee prostheses consist of | foot-ankle assembly, shank, socket, and suspension
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| foot ankle assembly for BKA | absorbs shock at heel strike, PF in early stance
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| What are some non-articulated feet | SACH foot (Solid Ankle Cushion Heel)
SAFE foot (Stationary attachment flexible endoskeleton)
Seattle foot
Fex-foot (Springlite foot)
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| SACH foot | MOST COMMON FOOT-non articulating, variety of cosmetic colors to match skin, durable, easy to use, rollover at terminal stance
-cushion heel permits PF in early stance and allows for a small amount of mediolateral and transverse motion
-can make many si
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| SAFE foot | -a version of SACH foot
-allows for walking on moderately uneven terrain because of the greater range of mediolateral motion permitted in the rear-foot
-active individuals
-disadvantage: heavier than SACH foot
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| Seattle foot | -slightly flexible plastic keel bends at heel contact
-keel stores energy and recoils in latte stance releasing energy for springy termination to stance
-disadvantage: heavier than SACH foot
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| Flex-Foot | -includes a long band of carbon fiber material, which extends from the toe to the proximal shank and to the posterior heel section
-the long bands acts as a leaf spring, enabling the foot to store energy in early and mid stance and the release it in late
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| What are some articulated feet | single-axis foot
multi-axis foot
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| single-axis foot | MOST COMMON articulating foot that permits PF and DF, as well as toe break action
-does not allow mediolateral or transverse motion
-may be prescribed for individuals with bilateral transfemoral amputations
-disadvantage: permits PF and DF only, limite
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| multi-axis foot | has components that move slightly in all planes to aid the patient in walking on uneven terrain and slopes
-disadvantage: heavier and less durable than single-axis or non-articulated feet
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| Shank | -provides leg length and shape
-transmits weight from socket to foot
-exoskeletal-usually made of wood with a plastic laminate finish that can be colored to match the skin-very durable
-endoskeletal-central aluminum or rigid plastic pylon covered with
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| Socket | patellar-tendon bearing (PTB)
-total contact socket that allows for maximum distribution of the load and assistance in venous blood circulation
-provides tactile feedback
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| Socket Reliefs | -reliefs are concavitites over PRESSURE SENSITIVE AREAs of the transtibial residual limb such a she anterior tibia, anterior tibial crest, fibular head and neck, and peroneal (fibular) nerve
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| Socket built-ups | are convexities over PRESSURE TOLERANT AREAs such as patellar tendon, medial tibial plateau, tibial and fibular shafts and distal end of tibia
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| Suspension | used to hold the socket onto the residual limb when non-weight bearing is occuring ex: swing phase
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| What types of suspension are there | -supracondylar suspension (SC)
-Supracondylar/suprapatellar suspension (SC/SP)
-Thigh corset suspension
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| Supracondylar suspension (SC) | -medial and lateral walls of the socket extend up and cover the femoral condyles
-a removable medial wedge is placed between the socket and the medial epicondyle
-more cosmetic with no buckles and increases mediolateral stability
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| Supracodylar/Suprapatellar suspension (SC/SP) | -similar to the SC with the addition of an anterior wall, which terminates above the patella
-used for SHORT RESIDUAL LIMBS
-may interfere with kneeling and is very visible when sitting
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| Thigh corset suspension | -has metal hinges attached distally to the medial and lateral aspects of the socket and proximally to a leather corset that may be as high as the ischial tuberosity
-it provides a larger area for weight bearing
-prescribed for individuals with SENSITIVE
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| what does an Above Knee prostheses (AK) consist of | -consist of foot-ankle assemble, shank, knee unit, socket, and suspension device
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| what type of knee unit AK prostheses are there | -enables to bend the knee when sitting and during ambulation
-single axis
-polycentric system (multiaxial)
-friction mechanism
-hydraulic knee units
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| Single-axis knee unit | permits knee motion around a fixed axis
-knee flexion is needed during late stance and swing phase
-knee locks in extension for heel strike and foot flat
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| Polycentric system knee unit | -allows for adjustment to the center of knee rotation
-more stable
-less used because of the greater complexity and other means to stabilize knee
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| Friction mechanism knee unit | -change the knee swing by modifying the speed of knee motion, providing resistance to pendulum motion at the knee
-the most popular is the constant friction unit which has a clamp that can vary the friction easily
-usually for older individuals who do n
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| Hydraulic knee units | -fluid controlled/pneumatic knee units (air controlled)
-adjust to the individual's walking speed and vary the resistance accordingly
-for younger more active individuals
-heavier, more complicated, require increased maintenance and have higher costs t
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| extension aids | -many knee units have a mechanism to assist knee extension during the latter part of swing phase
-elastic webbing located in front of the knee unit stretches during knee flexion (early swing)and recoils to extend the knee(late swing)
-an internal exten
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| mechanical stabilizer | -most knee units do not have a device to increase stability
-the prosthetic knee is aligned posterior to a line extending from the trochanter to the ankle assisting in maintaing knee extension
-a manual lock is a pin that limits knee flexion and is rele
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| Socket AK | -designed to be a total contact device that emphasizes loading on PRESSURE TOLERANT structures such as the ischial tuberosity, gluteal muscles, lateral side of the thigh and to a lesser extent the distal end of the amputation
-it limits the load on the P
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| Quadrilateral socket AK | -MOST COMMONLY USED FOR AKA
-uses a horizontal posterior shelf to support the ischial tuberosity and gluteals
-the medial wall is the SAME height as the posterior wall while the anterior and lateral walls are 2.5-3" higher
-reliefs are provided for th
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| What types of suspension are there for an AKA | -suction
-silesian bandage
-metal pelvic band
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| Suction suspension for AK | -employed to maximize contact and suspension
-air is pumped out a one way valve during weight bearing
-the individual wears a sock
-suction can be partial or total
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| Silesian bandage suspension for AK | -a strap that anchors the prosthesis by reaching around the pelvis
-controls for rotation
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| Metal pelvic band suspension for AK | -Includes a hinged hip joint attached to a leather/metal band anchored around the pelvis
-adds control for rotation, hip ADD/ABD
-REDUCES TRENDELENBURG GAIT
-adds extra weight
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