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Ortho PTA 205
Prosthetics
| Question | Answer |
|---|---|
| What is used to simulate shape & restore function? | Prosthetic |
| what is used as a temporary prosthetic? | pylon |
| why would you use a pylon? | to establish early ambulation post healing |
| is the pylon articulating? | no |
| characteristics of foot & ankle (tanstibial & transfemoral) articulating prosthetic | bolted w/bumpers or spring, single axis - DF/PF, multi axis-rotation/inv & ever |
| characteristics of non-articulating foot & ankle (transfemoral & transtibial) prosthetic | stationary attachment flexible endoskeleton (SAFE) or solid ankle cushioned heel (SACH) |
| what movements does a SAFE offer? | medial/lateral |
| what is the characteristic of SACH | rubber met head to toe, cushion for shock w/heel strike/stance |
| what simulates bone portion of extremity that has been removed? | shank |
| endo skeleton prosthetic is? | shank surrounded by foam, robber, lighter & more resilient |
| exo skeleton (rigid) prosthetic is? | plastic or wood exterior |
| socket of transtibial characteristics | receptacle for residual limb, custom molded, pressure is distributed w/relief as needed |
| transtibial, suspension maintains prosthetic during what phase of gait? | swing phase |
| how do you get a snug fit with transtibial w/suspension? | vacuum fit |
| endo skeleton (shank type) | shank (titanium) surrounded by foam rubber, looks like skin, pliable, less expensive to replace, lighter |
| articulating | foot bolted to lower shank w/bumpers or spring, dynamic |
| non articulate | no cleft between foot & lower shank, lighter wt, more durable & attractive |
| if the foot is bolted but there is ankle movement, which is articulating? | ankle.....it has movement |
| SAFE | Stationary attachment Flexible Endoskeleton.....rigid ankle block medial/lateral movement(pronation, supination, foot is pliable) |
| cushion heel helps how? | absorption |
| single axis is what movements? | DF, PF |
| multi axis is what movements? | rotation/Inversion & eversion |
| shank | simulates bone portion of extremity removed |
| exo skeleton (shank) | solid, modified PVC, whole device is designed to move. can chip away and break down, heavier |
| socket | what residual limb goes in, custom molded, sometimes lined (mole skin) |
| pressure relief | wt bearing residual limb to socket is decreased by providing padding |
| patellar tendon bearing....redness | improper pressure in that area, if it lasts more than just a few minutes, needs to be addressed |
| how to get skin used to pressure, avoid breakdown? | wearing schedule, on 1 hr, 2 hrs off, etc |
| transtibial, what maintains prosthetic during swing phase? | suspension with sleeve on extremity or supracondylar, belt on extremity or trunk, distal pin, brim (suprapatellar), or vacuum |
| suspension maintains prosthetic during what gait phase? | swing |
| how does a sleeve stay on? | compression force, hard leather like, rubber, goes around |
| distal pin | locks prosthesis in (combo suspension & rubber sleeve) |
| custom molded brim | hangs on boney prominence, not popular |
| custom molded stays on how? | vacuum pressure, button to release |
| transfemoral- suspension...how to keep on | total suction (vacuum) or partial, suction w/bandage or belt, or pin or belt |
| socket of transfemoral is what shape? | quadrilateral, can get a better grip, fit |
| ischial containment (transfemoral) | actually catch at the ischial or pelvis |
| dynamic knee | spring loaded, friction stops it, friction....wt on it...it won't bend, wt releases....it bends |
| dynamic locking | lock mechanism in knee, if knee is locked, need to circumduct to walk |
| disarticulation - knee & hip | have to consider wt bearing, hip & knee flex & ext, needs to be molded to pelvis or trunk |
| how many ply is a "sock"? | 2 -6 |
| how to make up for too much space in socket, pylon? | sock, be sure to note in SOAP note how many layers used....need to keep track of what is happening to residual limb |
| maintain sock | clean, dry, not worn, no wrinkles |
| what are socks made of? | silicone, cotton, wool |
| why good patient ed? | so if they need to call you they can identify parts |
| energy storage prosthesis | spring type |
| deviations in gait, lateral flexion caused by? | size of prosthesis, fit, varus or valgus, pain, strength, balance & ROM |
| deviation in gait, excessive knee flexion caused by? | socket set anterior, foot excessive DF, length & ankle articulation, contracture pain, strength & balance |
| deviation in gait, abducted or circumducted caused by? | size & fit, varus or valgus, poor suspension pain, strength, balance & ROM |
| what do we assess in a patient with a prosthesis? | joint ROM, strength, skin checks, pain/sensory issues, ENDURANCE, balance & coordination (strategies - hip, ankle, step), AD PRN, temporary available? |
| what muscles help in transfemoral? | hip and trunk makes up difference |
| deviation in gait, vaulting caused by? | length or suspension, excessive PF, pain, "catching" foot, varus or valgus |
| deviation in gait, rotation caused by? | excessive toe out/in, fit or suspension, length or firmness of ankle articulation, strength or ROM |
| deviation in gait, whip caused by? | excessive knee rotation, fit, varus or valgus strength, ROM or instability, break of foot |
| assess what in fit in static? | "feel", pistoning, misalignment (head to toe) |
| assess what in fit for dynamic? | misalignment, gain deviations (front, back & side) |
| with an articulate prothetic, how does the wearer get to foot-flat part of gait? | at early stance, wb'ing on the heel causes foot to PF, ensuring the wearer achieves foot-flatp |
| SACH | Solid Anke Cushioned Heel that allows very small amt of medial-lateral & transverse motion, rubber met head to toe, cushion for shock with heel strike/stance, good PF in early stance, most common,shock absorption, allows foot to hyperextend in late stance |
| which type of prosthesis is best on uneven surface? | articulating, multi-axis, |
| what does single axis prostethetic foot allow? | PF, DF, toe-break action, but not medial/lateral or transverse motion |
| what to places for pressure points w/transtibial prosthetic? | patellar tendon bearing, supracondylar, suprapatellar |
| craig-scott | paraplegia |
| hkafo control? how does it connect? | rotation @ hip, abdad, heavy, restrict's pt to swing-to or swing thru, connected to trunk w/pelvic band, trunk articulation below crest, above trochanter |
| reciprocating gait Orth ...RGO | pt shifts wt onto LE, cable system advances opposite LE, paraplegia |
| parapodiums | standing frame to allow a pt to sit when necessary. wt shifting & rocking base across the floor, pediatrics |
| corset | inc pressure & load, constructed of fabric, to control back pain, important not to get dependent on it |
| what orthotic can be used for back pain? | corset |
| rigid corset | bars or molded |
| what orthotic for scoliosis? | MILWAUKEE ( limits flex/ext) |
| what brace would be used for thoracolumbosacral? | Taylor....limits trunk flexion & ext thru 3 pt control design |
| what brace utilized to prevent all trunk motions & is commonly utilized as a means of post surgical stabilization? rigid shell, plastic, straps, velcro? | TLSO, thoracolumbosacral orthosis |
| what orthosis restricts all cervical motion? metal ring w/four posts that attach to a vest, commonly w/cervical SCI | Halo Vest Orthosis, Philadelphia 4 post (independent) |
| PT assess ? | STATIC, symmetry (shoulders, hips, etc), aligned, comfort & fit, don/doffing, DYNAMIC planes/views, trunk/spine, LE, phases of gait - OBSERVE FRONT, BACK AND FROM THE SIDE! |
| how is an orthotic scored? | Pass - 100% , Provisional Pass - almost, looking good but needs a small adjustment, Fail, needs to be remade |
| should an orthotic/brace be worn all the time? | only as long as necessary to not create a dependence |
| maintenance or orthotic | keep clean, dry & no hairdryer, loose srews/rivets/rust, sand? need lubrication? |
| shoe heel | post |
| shoe last | shape |
| shoe sole | bottom |
| shoe quarter | height, extra depth |
| shoe | foundation |
| shoe upper | over foot |
| closure | fit |
| reason for orthotic | prevent mechanical deformity, assist w/dec stg, maintain alignment, control tone, guard against injury, inc motion & independence |
| shape of heel support | sloped to dec pressure on heel |
| arch support does? | limits planus |
| metatarsal pad does? | disribute pressure off met heads |
| heel wedge does? | adjust for varus/valgus, promote rolling |
| metatarsal bar/rocker does? | distribute weight, keeps foot from traveling |
| purpose of a lift? | correct leg length, back pain |
| AFO formed how? | molded to foot, (subtalar neutral) angle & LE to control motion, metal uprights |
| what motion does AFO control? | DF (buckle) /PF (recurvatum) |
| KAFO - does? | LE weakness/paralysis, use w/full extension |
| KAFO mechanics | hinge @ knee, cap strap on knee, belt/shell, (Craig-Scott) |
| hemicorporectomy amputation | pelvis & both LE |
| hemipelvectomy | 1/2 pelvies & LE |
| AKA (transfemoral) | surgical removal above the knee joint, hip disarticulation, knee disarticulation |
| hip disarticulation | removal of the LE from the pelvis, leave pelvis |
| knee disarticulation | removal thru the knee jt |
| BKA | toe, symes (ankle)/Choparts (midfoot), tanstibial (somewhere along the tibia) |
| Symes | ankle, w/removal of the malleoli |
| Choparts | at the midtarsal jt |
| goal of amp? | preservation, would healing, prosthetic for function ( get mobile) |
| flaps | pliable, movable & painless, = length, long posterior, skew - scar away from bone |
| myoplasty | removal/stabilization/"plastic surgery" |
| mydesis | muscle to bone |
| tenodesis | tendon to bone |
| myofascial closure | capsule |
| "dog ears" | excessive skin, smooth, on either side, residual, skin |
| how to break up scar tissue? | massage, heat, US |
| nerve | distacted, cut retracting into limb, neuromas - collection close to bone/scar? |
| blood supply issues for PT to work on | massage, heat, exercise to get blood flowing, necessary for healing |
| phantom pain | desensitization, ice, heat, estim |
| why is WBing imp? | jagged edges can form calicifications in uneven pattern |
| rigid plaster casting | early amb w/pylon & strong protection (can't inspect), control edema & promote curculation |
| semi rigid dressing | Unna's or air, edema control & early amb, (can loose, requires more work), easily changed, not as strong as rigid, impregnated w/meds |
| soft dressing | most often used, ace or shrinker. controls edema, (risk for tourniquet), inexpensive, allows motion & inspection, frequent chgs & inc edema risk |
| PT whemipelvectomy | no residual limb for activation of prosthesis, must use wtbing, FOR GAIT - ILIOPSOAS, QUAD, GLUT |
| PT for transfemoral | GUARD AGAINST HIP FLEXION CONTRACTURE, NO PILLOWS!!!!, BALANCE AMBULATION & ENERGY |
| PT for knee disartic | WTBing on residual limb (stg hip & knee!, common misalignment of knee axis, strg & balance (knee, foot & ankle absent) |
| PT for Transtibial | WBing at patellar tendon, balance & strg |
| golden rules of wrapping | wrinkle free, angled 8, no circles, distal pressure, utilize the amt needed, complete coverage, wrap in extension, recheck often |
| shaping done with? | shrinker, ace wrap |
| PT first wk | out of bed, utilizing w/c--fit & use, amb w/AD (UE, LE & trunk stg) HEP, AD, monitoring skin/edmea/shaping, dehiscence (reopening), positioning (no pillows), dressing (wound care & ACE) MAKE THEM WT BEAR ON THAT SIDE |
| PT Tx | ROM/position - avoid pillows, utilize splint/board PRN, MMT, edema/skin checks - clean & moisturize, ambulation ASAP! Walker, crutches, w/ or w/o prosthetic, w/c, sensation - phantom limb pain ~ 80%, injection, US< stim, desens, MHP/CP |
Created by:
djbari
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