Amputation and Prosthetics

Question 1

Primary etiology for amputation
Second

Answer 1

peripheral vascular disease
diabetes

Question 2

forequarter (scapulothoracic) amputation

Answer 2

upper extremity including the shoulder girdle

Question 2

shoulder disarticulation

Answer 2

UE through shoulder

Question 2

Transhumeral

Answer 2

UE proximal to elbow joint

Question 3

elbow disarticulation

Answer 3

lower arm and hand through elbow joint

Question 4

transradial

Answer 4

UE distal to the elbow joint

Question 5

wrist articulation

Answer 5

hand through wrist joint

Question 6

partial hand

Answer 6

portion of the hand and/or digits at either the transcarpal, trasmetacarpal or transphalangeal

Question 7

digital amputation

Answer 7

removal of a digit at either metacarpophalangeal, proximal interphalangeal or distal interphalangeal

Question 8

Hemicorporectomy

Answer 8

removal of pelvis and both LE

Question 9

hemipelvectomy

Answer 9

removal of on half the pelvis and LE

Question 10

knee disarticulation

Answer 10

removal of the LE through knee joint

Question 11

Syme’s

Answer 11

removal of the foot at the ankle joint with removal of the malleoli

Question 12

transvers tarsal (Chopart’s)

Answer 12

through talonavicular and calcaneocuboid joints. preserves plantar flexors but sacrifices the DF resulting in equinus contracture

Question 13

Tarsometatarsal (Lisfranc)

Answer 13

removal of the metatarsals
preserves DF and PF

Question 14

Transradial socket covers….
may be shortened to allow for ….
supracondylar sockets are …. and require no additional harness

Answer 14

2/3 of forearm
increased pron/sup
self-suspending

Question 15

Transradial suspension options

Answer 15

triceps cuff
harness
cable sys

Question 16

Transradial elbow unit attaches to either … or upper arm pad.
… or….connects socket to proximal component.

Answer 16

triceps cuff
flexible or rigid

Question 17

Transradial wrist unit has what options

Answer 17

quick change unit
wrist flexion unit
ball and socket
constant friction

Question 18

Transradial terminal device has voluntary … or…
powered by….
type of hand

Answer 18

opening or closing
body-powered, externally powered, myoelectric or hybrid
hook, mechanical hand, cosmetic glove

Question 19

Transhumeral socket extends to …
modified design allows for stability with…
….units may be used with passive prosthetic arms

Answer 19

acromion level
rotational movements
lightweight friction

Question 20

Transhumeral suspension

Answer 20

harness
cable sys
suction

Question 21

Transhumeral elbow unit

Answer 21

internal or external locking elbow unit

Question 22

Transhumeral wrist unit and terminal device

Answer 22

same as transradial

Question 23

Transfemoral socket

Answer 23

quadrilateral socket ischial containment socket

Question 24

Transfemoral suspension

Answer 24

lanyard strap shuttle lock suction partial suction vacuum

Question 25

Transfemoral knee

Answer 25

single axis polycentric hydraulic microprocessor

Question 26

Transfemoral shank

Answer 26

exoskeleton-rigid endoskeleton-pylon covered with foam

Question 27

Transfemoral foot system

Answer 27

solid ankle cushion heel stationary attachment flexible endoskeleton single axis multi-axial hydraulic powered dynamic response

Question 28

Transtibial socket

Answer 28

patella tendon bearing supracondylar patella tendon socket supracondylar suprapatellar socket

Question 29

Transtibial suspension

Answer 29

supracondylar cuff thigh corset supracondylar brim rubber sleeve waist bel with fork strap suction with knee sleeve shuttle lock vacuum

Question 30

Transtibial knee

Answer 30

is not needed

Question 31

Transtibial shank and foot sys

Answer 31

same as transfemoral

Question 32

Rigid plaster of paris allows for early... promotes... stimulates... provides... and ... limits.... ability to utilize...

Answer 32

ambulation with pylon circulation and healing proprioception protection and soft tissue support edema IPOP

Question 33

Rigid plaster of Paris make immediate ... inspection not possible. Does not allow for ... Requires...

Answer 33

wound inspection daily dressing change professional application

Question 34

NWB Rigid removable limb protectors are .... accomodate.... are easily ....prevent... and provides....

Answer 34

removable edema fluctuation applied contracture protection

Question 35

NWB rigid removable limb protectors are not used for ...

Answer 35

ambulatory purposes

Question 36

Semi-rigid (unna paste, air splint) reduces....provides... and .... and are easily...

Answer 36

post-op swelling soft tissue support and protection changeable

Question 37

Semi-rigid does not protect as well as ....requires more....may loosen and allow for ...

Answer 37

rigid dressing more changing than rigid development of edema

Question 38

Soft (ACE wrap, shrinker) reduces ..., provides some..., relatively ....., easily removed for ..... allows for active joint ....

Answer 38

post-op edema protection inexpensive wound inspection ROM

Question 39

Soft causes interruption of.... due to frequent dressing changes. Joint ROM may.... healing of incision. Less control of .... cannot control amount of .... on bandage. Risk of .... effect. Shrinker cannot be applied until...

Answer 39

tissue healing delay residual limb pain tension tourniquet sutures/staples are removed

Question 40

K level is associated with

Answer 40

componentry that will be used for prothesis current level of function, potential ability for function and patients particular needs.

Question 41

K level is determined by

Answer 41

AMPPRO or through a thorough history and examination of patient. PT can make this level

Question 42

K level 0

Answer 42

prothesis will not enhance quality of life or mobility will not be eligible for prosthesis

Question 43

K level 1

Answer 43

transfers ambulate on level surfaces fixed cadence limited or unlimited household ambulator knee will be single axis or constant friction ankle will be SACH or single axis

Question 44

K level 2

Answer 44

traverse low-level barriers limited community ambulator knee will be polycentric or constant friction ankle will be flexible keel foot and multi-axial ankle

Question 45

K level 3

Answer 45

variable cadence ambulator unlimited community ambulator traverse most environmental barrers prosthetic use beyond simple locomotion knee will be hydralic, microprocessor, or variable friction. ankle will be energy storing, dynamic response, mutli-axial foot

Question 46

K level 4

Answer 46

exceeds basic ambulation skills exhibits high impact levels child, athlete or active adult any systems for knee and foot

Question 47

What areas are more tolerant for a socket?

Answer 47

muscular

Question 48

common design for transfemoral

Answer 48

ischial containment

Question 49

common design for transtib

Answer 49

total surface bearing or patellar tendon bearing socket

Question 50

liners are typically

Answer 50

gel and non-breathable so need to dry it.

Question 51

An insert can accomodate for ...

Answer 51

space in socket foam or flexible plastic

Question 52

hard insert can

Answer 52

relieve pressure through a series of buildups and reliefs molded in the insert

Question 53

Sock is worn to decrease limb volume especially in

Answer 53

first year

Question 54

Common plys of sock are

Answer 54

1,3,5

Question 55

General rule of thumb with socks

Answer 55

number of socks exceed 12-15, prosthetist needs to recast

Question 56

Pressure tolerant areas on transtib

Answer 56

patellar ligament lateral fibula shaft medial tibial shaft lateral tibial shaft

Question 57

Pressure sensitive areas on transtib

Answer 57

fibular head lateral tibial flare tibial crest distal end of fibula and tibia patella anterior tibial tubercle peroneal nerve adductor tubercle

Question 58

Pressure tolerant areas on transfem

Answer 58

ischium soft tissues of residual limb

Question 59

Pressure sensitive areas on transfem

Answer 59

greater trochanter pubic tubercle pubic ramus pubic symphysis distal end of femur perineum

Question 60

Lotion for limbs should be....and should not be applied prior to ....because it might inhibit suspension. If there is any breakdown of skin it should be....

Answer 60

not be petroleum based donning prosthesis prosthestist or physician before donning

Question 61

Break in schedule for prosthetic

Answer 61

first few weeks start with one hour of wear time a day with half of that being walking every 30 min inspect skin if tolerating all this well increase time to one more hour each day. When skin is doing well with no signs of breakdown, amount of time between inspections becomes 15-30 min more

Question 62

Most common complaint with a new prothesis is the

Answer 62

comfort of the socket

Question 63

Pre-prosthetic phase

Answer 63

6 weeks immediately post-op focus on protecting limb, preventing contractures, developing single limb mobility skills and preparing for prosthetic phase sometimes will be fit with IPOP-allows for immediate WB

Question 64

Patient will be evaluated for first prosthesis once ..

Answer 64

.sutures or staples are healed and skin integrity is intact 4-6 weeks. can begin wearing a shrinker when staples are removed

Question 65

First get a temporary prosthesis then go to

Answer 65

prosthetic phase of rehab

Question 66

How long does it take to get a good comfort and fit and what is required to get a permanent prosthesis

Answer 66

several months volume fluctuations have stabilized

Question 67

What wrapping strategies should you use with residual limbs?

Answer 67

no wrinkles diagonal and angular pattersn no circular patterns provide pressure distally to enhance shaping anchor wrap above knee for transtib and around pelvis for transfem promote full elbow extension for transradial promote full knee extension for transtib promote full hip extension for transfem secure wrap with tape not clips use 2-4 in wrap for UE 3-4 in wrap for transtib 6 in wrap for transfem rewrap frequently

Question 68

Common complications followed amputation

Answer 68

contractures DVT hypersensitivity neuroma phantom limb phantom pain psychological impact wound infections

Question 69

most likely contractures for transmet and Symes

Answer 69

equinus

Question 70

most likely contracture for transtib

Answer 70

knee flexion

Question 71

most likely contracture for transfem

Answer 71

hip flexion and abduction

Question 72

Most common cause for forequarter amputation loss of all what joint movements

Answer 72

malignancy shoulder, elbow and hand functional prosthetic is common

Question 73

Shoulder disartic is the loss of what joint movements? Most commonly result of ...? Functional prosthetic use .... What kind of shoulder?

Answer 73

all shoulder, elbow and hand function malignancy and severe electrical injuries is possible external prosthetic shoulder joint is typically required

Question 74

Two most common UE amputations

Answer 74

transradial transhumeral

Question 75

Transhumeral is the loss of all... most commonly due to... typically __-___cm proximal to the distal humeral condyles. If trauma associated fracture, dislocation or peripheral nerve injury it may....

Answer 75

elbow and hand function trauma 7-10 delay prosthetic interventions

Question 76

Elbow disarticulation is the loss of all... most commonly due to ... allows for .... socket. an external prosthetic .... is required.

Answer 76

elbow and hand function trauma self-suspending elbow joint

Question 77

Transradial is the loss of all ... must be a minimum of ___cm proximal to distal radius. Typically caused by... If it is trauma, dislocation or peripheral nerve injury it may... Functionally perferred over .... or ...

Answer 77

all hand function 5 trauma delay prosthetic interventions wrist disarticulations or selected partial hand amputations

Question 78

Wrist disarticulation is .... loss of all... .. and .... prosthetic disadvantages

Answer 78

uncommon hand function cosmetic and functional

Question 79

Partial hand amputation is the loss of a ... limb sparing technique utilized when... toe transfer to replace ... may be considered if prosthesis fails

Answer 79

digit/hand function functional pinch can be preserved thumb

Question 80

Digit amputation preserved function is highly variable depending on .... protheses are .... long transradial amputation may be more... if multiple digits are involved at proximal levels.

Answer 80

number of digits involved and level of amputation not typically utilized functional

Question 81

Hip disarticulation/hemipelvectomy all functions of .... most common cause... does not allow for activation of.... prosthetic limb advancement is initiated through...

Answer 81

hip, knee, ankle, and foot are absent malignancy prosthesis through residual limb pelvic motion

Question 82

Transfem length of residual limb with regard to... knee componentry will determine ability to ... stance control may not activate until... donning can be more difficult than with ... WB through ischium in an .... susceptible to .... adaptation required for balance....

Answer 82

leverage and energy expenditure functionally reciprocate gait WB occurs through limb transtib ischial containment socket hip flexion contracture weight of prosthesis and energy expenditure

Question 83

Knee disartic loss of all .... residual limb can ... susceptible to .... knee axis of prosthesis is... gait deviations can occur secondary to...

Answer 83

knee, ankle and foot function WB through its end hip flexion contractures below the natural axis of the knee malalignment of knee axis

Question 84

Transtib loss of ... WB in prosthesis should be ... areas of primary WB should be... adaptations required for... susceptible to both ...

Answer 84

active foot and ankle motions distributed over the total residual limb pressure tolerant balance knee and hip flexion contractures

Question 85

Symes loss of ... residual limb can WB... residual limb is ... with non-cosmetic appearance. dog ears must be .... for proper prosthetic fit. adaptation required for increased... adaptation required due to ....

Answer 85

all foot functions through its end bulbous reduced weight diminished toe off

Question 86

Trasmet and choparts is loss of ___,___,___,___ and tendency to develop.

Answer 86

forefoot leverage balance WB surface proprioception equinus deformity

Question 87

Prosthetic causes of lateral bending

Answer 87

too short improperly shaped lateral wall high medial wall prosthesis aligned in abd

Question 88

Amputee causes of lateral bending

Answer 88

poor balance abd contracture improper training short limb weak abd on prosthetic side hypersensitive and painful residual limb

Question 89

Prosthetic causes of abducted gait

Answer 89

too long high medial wall poorly shaped lateral wall prosthesis positioned in abd inadequate suspension excessive knee friction

Question 90

Amputee causes of abducted gait

Answer 90

abd contracture improper training adductor roll weak hip flexors and adductors pain over lateral residual limb

Question 91

Prosthetic causes of circumducted gait

Answer 91

too long excessive knee friction socket is too small excessive PF

Question 92

Amputee causes of circumducted gait

Answer 92

abd contracture improper training weak hip flexors lacks confidence to flex knee painful anterior distal residual limb inability to initiate prosthetic knee flexion

Question 93

Prosthetic causes of excessive knee flexion during stance

Answer 93

socket set forward in relation to foot excessive DF stiff heel too long

Question 94

Amputee causes of excessive knee flexion during stance

Answer 94

knee flexion contracture hip flexion contracture pain anteriorly in residual limb decrease in quad strength poor balance

Question 95

Prosthetic causes for vaulting

Answer 95

too long inadequate socket suspension excessive alignment stability excessive PF

Question 96

Amputee causes for vaulting

Answer 96

residual limb discomfort improper training fear of stubbing toe short residual limb painful hip/residual limb

Question 97

Prosthetic cause for rotation of forefoot at heel strike

Answer 97

excessive toe-out built in loose fitting socket inadequate suspension rigid SACH heel cusion

Question 98

Amputee causes for rotation of forefoot at heel strike

Answer 98

Poor muscle control improper training weak medial rotators short residual limb

Question 99

Prosthetic causes for forward trunk flexion

Answer 99

socket too big poor suspension knee instability

Question 100

Amputee causes for forward trunk flexion

Answer 100

hip flexion contracture weak hip extensors pain with ischial WB inability to initiate prosthetic knee flexion

Question 101

Prosthetic causes for medial or lateral whip

Answer 101

excessive rotation of the knee tight socket valgus in prosthetic knee improper alignment of toe break

Question 102

Amputee causes for medial or lateral whip

Answer 102

improper training weak hip rotators knee instability

Question 103

Limb loss specific out come measures: functional

Answer 103

AMPPRO-Amputee mobility predictor L-test

Question 104

AMPPRO

Answer 104

measure ambulatory potential of lower-limb prosthesis users. K-level

Question 105

L-test

Answer 105

assess amputee mobility Like the TUG but some differences: 90 degree turn is performed after initial 3 meters, total length ambulated is 20 meters not 6 like the TUG, four turns are involved.

Question 106

Limb loss specific outcome measures: patient based outcomes

Answer 106

Prosthesis Evaluation Questionnaire (PEQ) Orthotics Prosthetics User Survey (OPUS) Trinity Amputation and Prosthesis Experience Scales-revised (TAPES-R)

Question 107

PEQ

Answer 107

evaluate the prosthesis and life with it 9 scales that can be administered together in independently. Visual analog scale to assess satisfaction, well-being, frustration, pain, and residual limb health.

Question 108

OPUS

Answer 108

functional status, quality of life, satisfaction modules simple and be performed in part or in whole

Question 109

TAPES-R

Answer 109

multidimensional instrument examines psychosocial process involved in adjusting to using an a prosthesis. Four sections: activity restriction, psychosocial adjustment, satisfaction with prosthesis, and factors influencing health both related to and unrelated to amputation. Takes 15 min to administer and may be given in part or in whole.

Question 110

Acquired amputation

Answer 110

disease, trauma, infection traumatic or non-traumatic

Question 111

Endoskeletal shank

Answer 111

rigid pylon covered in material designed to simulated the contour and color of the contralateral limb

Question 112

Exoskeletal shank

Answer 112

rigid external frame covered with a thin layer of tinted plastic to match the skin color distally

Question 113

myodesis

Answer 113

anchoring muscle or tendon to bone using sutures drilled in bone. Help in closure process on residual limb.

Question 114

myoplasty

Answer 114

suturing amputated muscle flaps together over the end of a bone

Question 115

osseointegration

Answer 115

process of implanting a prosthetic device directly into residual limb of a person with limb loss. Negates the need for socket component.

Question 116

polycentric knee

Answer 116

multiple axes of rotation for more natural gait cycle

Question 117

pylon

Answer 117

pipe like structure used to connect the socket to the foot/ankle components assists with WB and shock absorption

Question 118

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