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Ortho PTA 205

Prosthetics

QuestionAnswer
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