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