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Amput n Prosthetics

Skills 3 Amputations and Prosthetics SRM

QuestionAnswer
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