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Prosthetics&Orthotics > L1: P&O INTRODUCTION > Flashcards

L1: P&O INTRODUCTION Flashcards

1
Q

OBJECTIVES:

GO OFF OF THESE WHEN REVIEWING DECK!!!

A
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2
Q

Many team members included with the P&O pt

These include…

A

Pt, family, ortho/vascular sx, social work, nurse, dietitian, psychologist, PCP, OT, CPO, PT***

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3
Q

Role of the Prosthetist

A
  • design, fabricate, fits prostheses or artif. limbs
  • create design to fit indiv’s particular functional and cosmetic needs
  • approp mats and components
  • casts, measurements and mods→ static/dynamic alignment
  • evals fit/function→ teaches pt how to take care of it
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4
Q

Role of the Orthotist

*often same person as prosthetist

A
  • Cares for pts w/ NMSK and MSK impairs that contribute to functional limits and disability→ design, fabricate and fitting orthoses/braces
  • functional and cosmetic needs
  • educates pt on proper use
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5
Q

Role of Physical Therapist

A
  • Assess pt as a WHOLE!
    • areas to be tx’d
      • skin, fine motor, strength, balance, ROM, pain, circulation
    • personality/condition
    • living arrangements
      • assist from others?
      • stairs?
      • activity lvls ***
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6
Q

Activity Lvl ex’s

A
  • Sedentary
  • Household or community ambulator
  • Athlete
  • etc..
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7
Q

Impairments, Functional Limits or Disabilities

Examples:

A
  • Dec comm access
  • Diff w/ manipulation skills
  • Edema
  • Jt contracture**
  • Impaired aerobic capacity (UBE***)
  • Impaired gait
  • Impaired integ and inadeq shape of RL
  • Impaired ADL perform.
  • RL pain
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8
Q

1 cause of amputations in Adults

A

PVD 82%

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9
Q

1 cause amputations in Children

A

Congenital 68%

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10
Q

Amputation and Gender/Age

A

Males 75%

Females 25%

Mean age amputation= 68yo

Mean age ambulatory amputee= 48yo

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11
Q

Top 3 Risk Factors/Predisposing factors for amputations

A
  1. Concurrent DM and HTN
  2. HTN w/o DM
  3. Dx w/o HTN

race, smoking, gender, vascular hx

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12
Q

Amputations occur _______ times more in diabetic pop

A

15x

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13
Q

___ to ___% amputations preventable w/ ______

A

50-70%

EDUCATION ***

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14
Q

Related to DM…

These 2 things together are the #1 cause of amputation

A

Chronic Arteriosclerosis Obliterans + DM

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15
Q

Half of neuropathic DM foot ulcers occur where

A

@ first three MET heads on plantar surface

most GRFs here***

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16
Q

Narrowing and hardening of arterial walls

pain, trophic changes such as hair loss and redness, intermittent claudication (pain w/ exercise or WB), swelling

A

PVD

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17
Q

MOST COMMON cause amputations in ADULTS

A

PVD***

ON TEST!!!!

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18
Q

EDUCATION for pts w/ fragile vascular limb

A
  • avoid trauma
    • footwear/avoid bare feet
  • skin inspection
    • cap refill, sensory, pulses
  • temp extremes
  • skin cleans
  • min. moisture
  • moisture— if too dry
  • med attn
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19
Q

GOAL of Sx if amputation necessary…

A

Preservation of as many anatomical joints as possible

*ESPECIALLY KNEE!!!

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20
Q

GOAL of amp. sx is preservation of as many jts as poss….

especially…

A

the Knee!!!!

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21
Q

Sx decision making process for amputation

What are we looking @?

A

Adequate Circulation

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22
Q

What goes into looking @ adequate circulation?

A
  • pulses in LE
  • skin color/condition
  • skin temp
  • ABI
  • TcPO2–transcutaneous oximetry
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23
Q

NOTE on ABI

A

Leg BP should be same or higher than arm @ rest AND after 5mins of exercise

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24
Q

During Amp Sx…. surgeon will traction the nerve

why?

A

Prevents retraction/recoil====Less phantom pain

25
Q

This is an extreme WB’ing tendon and is attempted to be preserved when poss.

A

Patellar tendon

26
Q

Myodesis

A

Re-attachment of mm’s onto bone OR periosteum (top aspect) of bone

27
Q

Myodesis and Transfemoral Amputations (aka Above Knee Amputation)

A

Adductors and Extensors lose their attachments and are reattached to distal femur

28
Q

W/ Transfemoral amps….Adductors and Extensors lose their attachments and are reattached to distal femur

What does this slight ADD do?

A

Slight ADD improves comfort during WB and maximizes ABD length-tension

29
Q

Transfemoral amputations

IMMEDIATE Surgical/PT goals:

A
  • Center femur/tibia in muscle mass
  • Balance forces
  • Strengthen RL
  • Prevent ADD roll (from adductor mm retraction)
    • in TFAs***
30
Q

Myodesis

Downside (TFAs):

A
  • Muscle does not hold sutures well→ not ideal for surgical attach’s
  • Fascia better @ holding sutures BUT not much around thigh mm’s
  • Often times→ myodesis unsuccessful limiting mm output and resulting in less than ideal alignment
  • SOME pts feel myodesis stretching out or pulling free
31
Q

This technique predominates in Transtibial Amputations (Below Knee Amps)

A

Myoplasty (muscle attached to opposing muscle)

32
Q

Myoplasty (muscle to opposing muscle) tech predominates in TTAs

Explain it

A

Long posterior myofascial flap sewn anteriorly to anterolateral deep fascia and tibial periosteum and provides reasonable degree of muscle fixation w/out risk of strangulation

33
Q

Muscle-to-bone suture aka

A

Myodesis

34
Q

Muscle-to-bone suture (myodesis) reserved for the _______ patient

A

NONischemic

(good/normal blood supply)

35
Q

REMEMBER….

W/ TTAs….

A

HS + Quads INTACT

Soleus REMOVED

36
Q

What is still intact w/ TTAs?

A

HS’s + Quads

37
Q

What is removed w/ TTAs

A

Soleus

38
Q

Surgeries from Distal→Proximal

A
  1. Phalangeal (forefoot)
  2. Transmetatarsal (midfoot)
  3. Lisfranc (tarsometatarsal (TMT) joint)
  4. Chopart (bw talus and navicular and calcaneus and cuboids→ still working ankle in sag. plane)
  5. Syme amputation (talocrural disarticulation)
    1. shave malleoli to create flat WB surface and repositioning of fat pad under tib/fib
39
Q

Surgery

Phalangeal or

A

Forefoot

40
Q

Surgery

Transmetatarsal or

A

Midfoot

41
Q

Surgery

Lisfranc or

A

Tarsometatarsal

42
Q

Surgery

Chopart or

A

Bw talus and navicular and calcaneous and cuboids

*still working ankle in sag. plane

43
Q

Surgery

Symes Amputation or

A

Talocrural disarticulation

*shave malleoli to create flat WB surface and repositioning of fat pad under tib/fib → thickest fat pad in body

44
Q

Surgery

Transtibial (BKA)

Ideal length

A

40-50% of initial tib length

45
Q

Surgery

TTA (BKA)

Shorter Tibia Length

A

<33%

Very LITTLE control of prosthetic

46
Q

Surgery

TTA (BKA)

Longer Tibia Length

A

>66%

BETTER control of prosthetic AND more surf area dispersion…BUT often chronic skin irritation and sharper distal tib

47
Q

Surgery

TTA

pics

A

see pics

48
Q

Post-Sx Transtibial Length

A

see pics

49
Q

Disarticulation safer vs Amputation

Why?

A

Less blood loss

Quicker sx + recovery (less chance for infx)

Nothing cut

50
Q

Sx:

Knee Disarticulation/Transcondylar

aka Remove tib/fib

Explain Benefits

A
  • LESS blood loss
  • Quicker sx+recovery
    • less chance for infx
  • Sx does NOT transect (cut) any mm mass
  • **Distal femur ideal for WB
  • Growth plate remains intact (children)
51
Q

Sx:

Knee Disarticulation/Transcondylar

aka Remove tib/fib

Explain Negatives

A

Femoral condyles (size) make don/doffing prosthesis difficult

*need shaved or special socket

52
Q

Sx:

Transfemoral (AKA) Amputation

Preserve length of femur allows for:

A
  • INCd prosthetic control
  • Improved stabilization of RL due to INCd ADD/ABD strength
  • LESS chance of hip ABD and hip flex contracture
53
Q

Sx:

Hip Disarticulation

What is removed + more info?

A
  • Entire femur, tibia, fibula, and foot removed.
  • Extreme sx and only performed under emergency cases
  • very few functional ambulators
54
Q

Sx: uncommon

Hemipelvectomy

A
  • Innominate bone AND distal LE removed
  • No bony casing for abdom contents
  • Often need NG tubes for feeding
  • Min activity allowed post-op
55
Q

Sx: uncommon

Hemicorporectomy

A
  • Translumbar amputation→ removing entire bony pelvis, pelvic contents, external genitalia, LEs
  • Rehab for ADLs, upright postures and balance
  • Typ NOT gait candidates
56
Q

Post-Amputation Sx:

Rehab Day 2:

Working on…

A
  • Pt and limb positioning
    • adduction and extension***
      • length-tension and prevent contractures
  • Stump shaping
    • shrinkers***
  • Wound care
  • Sitting balance
    • COM shift, circulation changes***
  • SL gait w/out prosthesis
57
Q

Post-Amputation Sx:

Depending on condition of suture line, fitting for initial prosthesis from….

A

From 3-6wks to several months

58
Q

Post-amputation Sx:

Regardless of lvl of amputee OR sx technique…….

A

The EARLIER the fitting and use of a prosthesis the BETTER the outcomes for functional ambulation.****

Prosthetics&Orthotics (19 decks)

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