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Flashcards in Exam 3 Deck (55)
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1

Soft Dressings consist of:

  • gauze, cotton padding and an elastic bandage
  • most commonly used dressing postoperatively
  • (ACE Bandage/Wrapping and/or Shrinker)

2

Soft dressing advantages:

  •  

3

Types of Dressings (3)

  • Soft
  • Semi-Rigid
  • Rigid

4

Types of Rigid Dressings

  • Immediate postoperative prosthesis
  • Rigid Removable Dressing
  • (Plaster of Paris)

5

Types of Semi-Rigid Dressings

  • Unna Boot
  • Air Splint/Pneumatic Post Amputation Mobility Aid (PPAM)

6

Phantom Pain Treatment options:

  • Manual Therapy
    • e.g. Tapotement
  • Electrical Modalities
    • e.g. TENS
  • Electroconvulsive Therapy
  • Stress management and voluntary muscle relaxation
    • biofeedback
  • Ultrasound

7

4 Types of exercise:

  • Positioning
  • Flexibility
  • Desensitization Activities
  • Strengthening

8

Pressure relief techniques days 1 - 10

  • ADL's
    • Bed Mobility Skills
    • Transfer training

9

Knee Types

  • Polycentric
  • Single Axis

10

Types of Friction for knees:

  • Mechanical
  • Pneumatic
  • Hydraulic
  • Modular Ergonomically Balanced Stride Polycentric

11

Knee Braking or Locking Mechanisms

  • Stance control knee
    • micrprocessor control

12

IPOP Advantages

  • control and shaping of residual limb
  • protection of the surgical site
  • improved healing time
  • maintenance of residual and sound limb and upper body strength
  • reduction of contracture development
  • maintenance of cardiovascular status
  • early return to balance and ambulation
  • social and emotional benefits
  • shorter hospital stay
  • shorter overall recovery time
  • quicker identification of patient functional levels

13

IPOP Disadvantages

  • impaired healing
  • lack of easy inspection of the incision site
  • falls or injury due to early ambulation

14

IPOP Contraindications

  • Hx of slow healing
  • Extreme obesity
  • Excessive pre-operative edema
  • Lack of 45 days of preoperative ambulation

15

Benefits of patellar tendon bearing socket:

  • offers areas of pressure and areas of relief

16

Indications for a hydraulic knee unit:

  • Walk at varying cadences
  • Walk on uneven ground
  • Patient unhappy with cadence response or lack of stability in mechanical friction knees
  • Take small steps in their occupation

17

Disadvantages of a hydraulic knee unit (2):

  • Increased expense
  • Increased weight

18

Indication and Benefits of traditional suction suspensions:

Indication:

  • Most patients with stable volume residual limbs

Benefits:

  • Increased comfort and cosmetic appearance
  • Increased proprioception
  • Decreased piston action

 

 

19

Disadvantages of traditional suction suspension:

  • Fitting may be difficult
    • especially in the presence of scarring, volume changes, or weight changes
  • May be unsuitable for individuals with balance problems, upper limb deficiencies, strength problems, or cardiovascular problems due to amount of effort required for application
  • Perspiration problems may cause development of rashes

20

Indication and benefit of roll on suction:

Indication:

  • Those who cannot apply digital suction

Benefits:

  • (Same as traditional suction)
  • Increased comfort and cosmetic appearance
  • Increased proprioception
  • Decreased piston action

21

Disadvantages of roll on suction:

  • Same as traditional suction
  • Also
    • not as durable
    • Excessive perspiration and heat
    • May not fit all sizes

22

Five types of conventional foot-ankle assemblies:

  • Single axis foot
    • internal keel, molder rubber shell, metal single axis joint, PF/DF bumpers
  • Multiple axis foot
    • offers inversion, eversion and rotation
    • good for hikers, golfers and those with brittle skin
  • Solid ankle cushioned heel (SACH):
    • one of the most common assemblies
    • good general use foot
    • no propulsion at terminal stance
  • Stationary attachment Flexible endoskeletal
    • Accomodates to uneven surfaces
  • Stored Energy Foot
    • keel compresses in the loading response of gait and stores energy
    • offers smooth stance roll over
    • allows a lot of motion and accomodates numerous shoe styles

23

Hydraulic vs. Mechanical knee friction

  • Mechanical:
    • Uniform resistance provided by constant friction
    • adjustable to the wearer's cadence (but not responsive to changes in cadence)
    • durable and inexpensive
    • no stance stability
    • Too rapid of gait results in vaulting or excessive heel rise
    • Rarely used unless patient is in remote area with limited access to prosthetist
  • Hydraulic:
    • Allow ambulation at any speed
    • resistance compensates for speed

24

Areas of weight bearing in a PTB socket:

  • Patellar tendon
  • Flare of the medial tibial condyle and the anteromedial aspect of the tibial shaft
  • Anterolateral aspect of the of the residual limb
  • midshaft of the fibula
  • Gentle end bearing as tolerated

25

Areas of relief in a PTB socket:

  • Anterior and lateral edges of the lateral tibial condyle
  • Head and distal end of the fibula
  • Crest and tubercle of the tibia
  • Anterior distal end of the tibia

26

Upper extremity hand grips (5):

  • Precision (pinch)

    • To pinch a small object

    • Thread needle, grain of rice

  • Tripod (pinch)

    • 3-jaw chuck

  • Lateral

    • Turning a key in a lock

  • Power hook

    • Carrying a briefcase by the handle

  • Spherical

    • Screwing in a light bulb, opening a doorknob

27

Steps of falling:

  • Attempt to throw weight toward the sound side by bending at the waist
  • Break the fall, if possible, with the hands
  • Roll onto the sound side

28

What causes medial (or lateral) whip for transfemoral amputation?

  • Faulty socket contours
  • Knee bolt externally (or internally) rotated
  • Foot malrotated
  • Prosthesis donned in malrotation
  • With sliding friction unit, fast pace
  • Per text: muscle weakness of the residual limb can result in rotation of the soft tissue and prosthesis over underlying bone (whip at toe-off)

29

Why would a transtibial patient exhibit excessive ipsilateral knee flexion when transitioning from Initial contact to weight acceptance (heel)?

  • High shoe heel
  • Stiff heel cushion
  • Socket too far anterior
  • Foot too far posterior

30

What commonly causes a circumducted gait for a transfemoral amputee?

  • Socket too small
    • or limb too big
  • Extension aid is too tight
  • Excessive friction in the knee
  • Plantarflexed foot
  • Loose suspension may cause pistoning
  • Also
    • hip abduction contracture
    • habitual circumduction due to fear of stubbing the toe
    • residual limb discomfort