Exam 3 Flashcards
(334 cards)
1
Q
What is bariatrics?
A
Field of medicine that offers treatment to overweight people with a comprehensive program
Includes diet and nutrition, exercise, behavior modification, and lifestyle changes
May be indicated for appetite suppressants and other appropriate meds
2
Q
Define body composition
A
Ratio of fat-free (bone, muscle, and water) to fat mass (adipose)
Expressed as percentage of body-fat or percentage of lean body mass
3
Q
Define BMI
A
Accounts for height and weight to determine obesity
4
Q
What BMI determines obesity?
A
> 30
5
Q
Why is BMI measurement flawed?
A
Does not separate body fat from other body tissue
6
Q
What body fat % determines if a man is obese?
A
25%
7
Q
What body fat % determines if a woman is obese?
A
> 30%
8
Q
Define body fat measurement
A
Take body fat compared to the other weight of the body
9
Q
What BMI is considered morbidly obese?
A
> 40
10
Q
What other comorbidities is obesity linked to?
A
MS disorders
Pain
Reduced cognitive performance
11
Q
What is the BMI formula?
A
Mass (lb) x 703/height (in)^2
12
Q
Define overweight in terms of body fat
A
Excessive amount of body weight that includes mm, bone, fat, and water
13
Q
What is hydrostatic weighing?
A
Subtract body weight measured in water during submersion from body weight on land
= Displaced water
14
Q
What variables must you know prior to hydrostatic weighing?
A
Residual volume
Density of water (altered with temp)
Estimated gas trapped in GI system
Dry body weight
15
Q
What is important to do before submerging individual in water?
A
Exhale as much air as possible
16
Q
What is the reliability of hydrostatic weighing?
A
High reliability
Gold standard
17
Q
Define Archimedes’ Principle
A
Law of physics
Upward force (buoyancy) of body immersed in fluid EQUALS the weight of displaced fluid
18
Q
What is Air Displace Plethysmography?
A
AKA BOD POD Sys
Subtracting volume of air in chamber when subject is in chamber from volume of air when chamber is empty
Thoracic gas volume is measured and subtracted
19
Q
What is the reliability of the BOD POD?
A
High reliability, but not as high as hydrostatic weighing
20
Q
What is DEXA?
A
Use low-level radiation to determine masses of fat, lean tissue, and bone mineral content
Also used in osteoporosis and osteopenia patients
21
Q
What is the limitation of DEXA?
A
> 300 lbs
22
Q
What is the theory of bioelectrical impedance?
A
Lean tissue (mostly water and electrolytes) is a GOOD electrical CONDUCTOR (low impedance)
Fat is a POOR electrical CONDUCTOR and acts as impedance to electrical current
23
Q
How does bioelectrical impedance work?
A
Subject stands or grasps onto stainless steel electrodes or analyzer
24
Q
What is a drawback to bioelectrical impedance?
A
Underestimate body fat for those who are obese and overestimates for those who are lean
25
What affects bioelectrical impedance?
Hydration level and exercise status
26
What is a skinfold measurement?
Based on the principle that subcutaneous fat is directly proportional to the total amount of body fat
27
What side of the body is skinfold measurement conducted on?
Right
28
How many sites are there in skinfold measurement?
7 sites
29
What determines reliability of skinfold measurements?
Specific to equation used
30
What do the equations of skinfold measurements indicate?
Body fat percentage
31
What is waist to hip ratio?
Waist circumference divided by hip circumference
32
What does waist to hip ratio indicate?
Strong correlation to risk factors of heart disease
33
Where do you measure in waist to hip ratio?
Waist - more inferior rib cage
Hips - around greater trochanters and iliac bones
34
What are common comorbidities to obesity?
```
CAD
HTN
Certain types of cancer
Elevated cholesterol
Type II Diabetes
Gall bladder disease
Sleep Apnea
OA
```
35
What are the causes of obesity?
Cal consumption > cal burned
Genetic factors
Environmental and social factors
Illnesses that lead to weight gain/obesity - hypothyroidism or Cushings
Lack of sleep
Drugs
36
What drugs can cause obesity?
Steroids
Some antidepressants
Some meds for psychiatric conditions or seizure disorders
37
What is Cushing's Syndrome?
Body exposed to high levels of CORTISOL for a long time
38
What are possible causes of Cushings?
Oral corticosteroid meds
39
What are sx/sx of Cushing's?
Fatty hump
Rounded face
Pink/purple stretch marks
40
What are bariatric surgical interventions?
Gastric bypass
Lap Band
Panniculectomy
41
What is gastric bypass?
Create new routing system
Absorb less nutrients
Better for diabetes
42
What is a lap band?
Creates a smaller stomach by cinching a portion
43
What is a Panniculectomy?
Getting rid of excess skin
44
What are the precautions to think of when someone had a panniculectomy?
Reduce infections
Decrease secondary MS complications
Decrease weight of excess skin
45
What is apple ascites distribution?
More abdominal mass (high waist to hip ratio)
Ascites - fluid accumulation (firm or hard) and fluid does not move easily
46
What is apple pannus distribution?
Extra skin and more moveable
High waist to hip ratio
47
What is pear abducted distribution?
Narrow abdomen, but larger hip area.
More fat medially causing hips to ABD
48
What is pear adducted distribution?
More fat laterally causing hips to ADD
49
What positions do those with apple ascites have difficulty staying in?
Flat or prone
50
What positions do those with apple ascites prefer?
Semi-fowler
51
What are complications of apple ascites?
Very poor endurance
Activity limitations due to SOB with exertion
52
What postural adaptations are common in those with apple ascites distribution?
Hypertrophy of respiratory accessory Mm
Convexity of cerv region
Jugular Vn distention
Elevated clavicles and seek postures to stabilize UE on surfaces
53
What are mobility patterns in those with apple ascites?
Supine to sit via supine on elbows - flat spin on bed until perpendicular and elevate trunk by virtue of pt moving hips to EOB. May require a wider bed
Immobile abdominal mass makes breathing difficult. Avoid flat postures - log roll
54
Can those with apple pannus tolerate flat positions?
Depending on distribution of pannus patient may tolerate supine
If there is restriction from diaphragmatic excursion - pt will most likely prefer s/l
55
What activity is more tolerable in those with apple pannus distribution?
May have better endurance and distance amb because of less trunk restriction
56
How does someone with apple pannus distribution get from supine to sit?
Some use supine flat spin to perpendicular to sit up at EOB
57
How does someone with apple pannus distribution get on/off bed?
Prone entry on 4-point
Scoop pannus with one hand and enter prone
58
What are characteristics of those with pear abducted distribution?
Very low waist to hip ratio
Majority of tissue bulk is BELOW belt line and femurs are ABD
59
How do pt with pear abducted distribution position?
Supine tolerant
60
How is breathing for those with pear abducted positions?
Able to breath without much obstruction
61
How is the mobility in those with pear abducted positions?
Difficulty rolling d/t extreme ABD LE
Usually move from supine to long sit and then short sit over EOB
62
What are equipment implications of those with pear abducted distribution?
Narrower, lower bed, and wider w/c
63
What are characteristics of pear adduction?
Most tissue bulk below belt line and LOW waist to hip ratio
Majority of tissue bulk is on the lateral aspect of the thighs and femurs ADD
Easier access to pericare and hygiene
64
How is mobility in those with pear adduction?
Supine to long sit and then short sit
Able to log roll
65
What are indications for treatment in those who are obese?
Weakness
Impaired functional mobility
CP implications
Decrease endurance
MS pain or injury
Gait training
Balance
66
What are contraindications/precautions for treatment in obese?
Monitor VS
Follow protocols
Use appropriate equipment and look at weight limits
67
Define Modified Eggress
Goes through getting up and out of bed
68
Define Original Eggress
Looks at a patient only already sitting EOB
69
What should be included in documentation of bariatric patients?
VS, pain, strength, ROM, posture, body type, and sensation
Aerobic capacity, resp status, balance, and skin integrity
70
What are common interventions in bariatric patients?
Wound care
Bed mobility
Transfer training
Gait/aerobic exercise
Strengthening
Pt education
71
What are the 3 components of the Egress Test?
Sit to/from stand x 3 reps
Marching x 3 steps
Advance step and return each foot
72
Define Average Daily Wage (ADW)
Calculation of an injured worker's average daily earnings
Sometimes used to determine entitlement to wage loss benefits following injury
73
Define Average Weekly Wage (AWW)
Similar calculation to ADW by determining entitlement to wage loss benefits by week for a fixed period of time
74
Define Functional Capacity Eval
A comprehensive battery of performance based tests that are commonly used to determine ability for work, ADLs, and leisure activities
Determine percent of impairment
75
Define Independent Medical Exam (IME)
Determines compensability, the extent of disability, necessity of treatment and type of tx, and/or to eval permanent disability or loss of earning capacity
Typically performed by a MD that knows nothing about the pt in ordef or an objective assessment
Can see same MD if post-op
76
Who can request an IME?
Insurance company or employer
77
How often is an IME performed?
Generally once every 6 months
78
How far away can IME be?
Within 100 mile radius
79
Define Permanent Partial Disability (PPD)
Benefits to employee who has sustained a permanent, but not complete disability
80
Define Permanent Total Disability (PTD)
Benefits if an injured employee is permanently AND totally disabled from work
81
Define Temporary Partial Disability (TPD)
Benefits available to injured employees who are able to work despite their injuries
82
Define Temporary Total Disability (TTD)
Benefits available to employees whose injuries leave them totally unable to work for a period of time
83
Define Statewide Average Weekly Wage (SAWW)
A computation of average wages paid to employees in a jurisdiction for set period of time
Used to calculate min and max amt of workers comp benefits that an injured employee will be entitled to receive
84
Define Social Security Disability Benefits (SSDI)
Benefits payable to disabled individuals through SS admin
85
Define Vocational Rehab
A variety of services that offered to injured employee to help them return to work
Part of work conditioning team
Help get pt back to work with restrictions
86
Define work hardening
Interdisciplinary, individualized, job specific program
Uses real or simulated work tasks and progress graded conditioning exercises specific to pt
Provide transitions
87
What is the goal of work hardening?
Return pt to work
Designed to improve biomechanical, neuromuscular, CV, and psychosocial functions
88
What terms are more common to use now for work hardening?
Occupational or Worker's Rehab
Interdisciplinary, outcomes focused, and individualized program to address medical, psychosocial, behavioral, physical, functional, and vocational components of returning to work
89
What does work hardening address?
Physical tolerances
Job specific physical rehab
Productivity
Workplace safety
Job performance and injury prevention
Worker behaviors
90
Define work conditioning
Intensive, work-related, goal-oriented conditioning program designed specifically to restore systemic neuromuscular functions, muscle performance, motor function, ROM, and CV and pulm function
91
What is the goal of work conditioning?
Restore physical capacity and function to enable patient/client to return to work
92
Who provides work conditioning?
May provided by one discipline
93
What are the 7 components of work hardening?
1. Strength and endurance
2. Simulation of critical work demands
3. Education
4. Job modifications
5. Individualized written plan
6. Safe work environment
7. Reporting system
94
What is involved during strength and endurance in working hardening programs?
Individualized program
Use equipment and tools to measure strength and conditioning - IE. Ergometers, dynamometers, and treadmills
Use strength and exercise devices, free weights, and circuit training
95
What is the goal of strength and endurance during work hardening?
Each worker is dependent on the demands of respective jobs
96
How do we simulate the critical work demands?
Progression in frequency, load, and duration
Must be work related and include a variety of work stations that offer opportunities to practice work related positions and motions
97
Why is education important in work hardening?
Body mechanics, work pacing, safety and injury prevention, and promote worker responsibility and self-management
98
What components are required during education of work hardening?
Direct clinician/work interaction
Program should cover A&P, back care, posture, and pain management
Role of exercise and worker's responsibility in self-treatment
99
What adaptations may be needed for job modifications?
Added equipment
Change in work position/ergonomics
Change in/at work place environment
Adaptations should be trialed/practiced
100
What is part of the individualized written plan?
Observable and measurable goals
Methods to reach goals
Projected time necessary to accomplish goals
Expected out comes
101
What component helps to write individualized written plan?
FCE
102
Define FCE
Standardized and validated advanced levels of testing
Determines safe job matches to return to work
Assess levels of reasonable accommodations
Assignment of level of disability for permanent or partial impairment status
103
Who determines the level of disability for permanent or partial impairment status?
Medical provider
104
When is FCE performed?
Completed within the first 2-3 days of program
Results compared to critical demands stated on job description/analysis
105
What is included of the safe work environment and atmosphere in work hardening?
Need a designated, separate, work-hardening area - at least 100 square feet per patient
Appropriate to vocational goal and the worker
106
What is included with the reporting system of work hardening?
Documentation of initial plan
Meeting with the worker and essential team members after the first 5 working days of the program
Discharge summary
Record of daily attendance including # of days and hours per day
107
What are the 4 criteria components of admission to work hardening?
1. Physical recovery sufficient for a progressive program and participation of min 4 hr/day for 3-5 day/wk
2. A defined RTW goal
3. Worker must be able to benefit from program
4. Worker can be no more than 2 years post injury date
108
What kind of exceptions are there to the amount of time spent in work hardening?
Hand injuries and other specialized diagnoses - may begin at 2-3 hr/day
109
What other components are needed for being admitted for the full time of work-hardening?
Must have no severe psychopathology
Must have motivation to RTW
Non-related medical probs stabilized
Physician referral
110
What components are included in the RTW goal?
Documented specific job to return to with job analysis OR documented on-the-job training OR a job title
111
How do you know if a worker will benefit from work hardening?
Screening process that includes file review, interview, and testing
Determines success in program
112
Why is progression in work hardening so important?
Strong evidence predicts people will begin to develop a disability mindset at 4 weeks away from work
113
What is a work hardening timeline?
Should be completed in 4 weeks or less (usually more like 4-12 weeks)
Some may RTW on modified, light and/or part-time basis
114
What are exceptions to work hardening timelines?
Must be preauthorized (Every 4 weeks)
Must be justified by diagnosis
115
What is the criteria for discharge from work hardening?
Goal(s) achieved
Lack of achievement/participation - has not met interim goals or has been absent for more than allowed or non-adherence to schedule
Goal(s) discovered not feasible
- Unknown med prob discovered
- Clinician decides the physical goals are not attainable
- Job not available
116
What kind of supervision is needed during work hardening?
Must be a licensed PT or OT
Ratio of NO LESS THAN 1 licensed therapist to every 6 patients
117
Define Level I acute management
Acute stage of rehab
Days 1-3
118
Define Level II of acute management
Sub-acute stage of rehab
Days 4 to 3 weeks
119
Define Level III of acute management
Chronic stage of rehab
3 weeks to months/years
120
What are other levels of management?
Acute Injury Management
Work conditioning
Work hardening
121
What other components are important in acute injury management?
Determine hx of current condition or injury
Eval occupational/job performance demands
Perform physical exam
Determine gaps in existing performance and job demands
Remediate the difference in timely manner with a focus on case resolution
122
Define levels of involvement in work conditioning
Systematic approach used to the restoration of work performance skills of injured workers recovering from long-term injury or illness
Single discipline involvement
Focus on restoration of musculoskeletal, CV, and safe work demand performance
Circuit training and work simulation
123
Define levels of involvement in work hardening
Multidisciplinary, systematic approach used in restoration of work performance skills of injured workers recovering from long-term injury or illness
Identical to work conditioning design with addition of PSYCHOMEDICAL counseling, ergonomics, and job coaching/transitional work
Typically 5 days/week for 2-4+ hours
May progress to transitional work programming with actual performance of job duties at their site of employment
124
What is involved during a progress note in work hardening?
Min every 2 weeks
Always prior to MD visit
Includes comparison of previous assessment of musculoskeletal functional abilities to current
Indicates progress or lack of
Outlines goals met and goals to be achieved
Recommendations and summary to include reasons for continuing or discharging
125
What are the payer sources for work hardening?
Workers comp
State agencies (Bureaus of Vocational Rehab)
Legal settlements
126
What are the codes used in work hardening?
97545
97546
127
What is 97545 in work hardening?
Work hardening/conditioning for the initial 2 hours
Does NOT require direct 1:1 contact; however, needs individualized programs
128
What is 97546 in work hardening?
Used for each additional hour after 97545
Can be utilized without 97545
129
What if only 1 hour of care is provided in work hardening?
Can be argued that you are not at the level of work hardening/conditioning
Then, can use 97110 or 97530
130
What is Phase I of Amputee Rehab?
Acute/protective healing
131
What is Phase II of Amputee Rehab?
Pre-prosthetic training
132
What is Phase III of Amputee Rehab?
Prosthetic training
133
What is Phase IV of Amputee Rehab?
Advanced prosthetic training
134
What phase of amputee rehab training is most important?
Phase II
135
What are the advantages of rigid dressing for amputees?
Allow early amb
Promote circulation and healing
Stim proprioception
Provide protection
Provide soft tissue support
Limit edema
Ability to use IPOP
136
What is an IPOP?
Immediate post-op prosthesis
Not common
137
What are the disadvantages of rigid dressing for amputees?
Immediate wound inspection is not possible
Does not allow for daily dressing change
Require professional application
138
What are the advantages to semi-rigid dressing for amputees?
Reduce post-op edema
Provide soft tissue support
Allow early amb
Provide protection
Easily changeable
139
What are disadvantages to semi-rigid dressing for amputees?
Does not protect as well as rigid
Requires more changing
May loosen and allow for edema development
140
What are advantages to soft dressing for amputees?
Reduce post-op edema
Provide some protection
Relatively inexpensive
Easily removed for sound inspection
Allow for active joint ROM
141
What are disadvantages to soft dressing for amputees?
Does not protect as well as rigid
Requires more changing
May loosen and allow for development of edema
142
What are common types of soft bandaging for amputees?
Ace wrap and shrinker
143
What occurs during PT exam with amputee?
History
Systems review
Skin
Residual limb length and shape
Emotional status
Vascularity
ROM
Mm strength
Neuro
Functional status
144
What are the functional treatment techniques for amputees?
Residual limb care
Limb wrapping
Positioning
Management of contractures
Therapeutic Ex
Transfer training
Balance
Amb
W/c management
145
How to properly care for residual limb?
Proper skin and hygiene care
Keep clean and dry
Provide pressure relief
Avoid cuts, abrasions, and other skin irritants
Self inspection of limb using mirror, visually, consider decreased sensation, and impaired vascularity
Bathe normally once incision has healed and sutures are removed
Night bathing encouraged - limb becomes a little edematous after
Dermatological conditions to be aware of that are contraindication
146
What dermatological conditions are contraindicated with limb wrapping?
Eczema
Psoriasis
Dermatitis
147
What occurs with desensitization of amputees?
Phantom pain
148
How to treat desensitization of amputee?
STM, pressure, various textures, lotions, massage with washcloth, etc
Mirror therapy
Psych considerations
149
Where does phantom pain come from?
Signal from brain
150
Why does mirror therapy work?
Thoughts of movement initiation normally come through SC (descending path) and synapses at the level of muscle
CNS is still working to map sensation and does not know it is missing the distal synapse. No information is ascending but is still descending
151
What are the two types of limb wrapping?
Shrinkers
Elastic wrap
152
What is the purpose of limb wrapping?
Reduce size of residual limb for those not fit with rigid, removable rigid, or temp prosthesis
153
What are the pros to shrinkers?
Easier to apply
Option for pt who are unable to properly limb wrap
154
What are the cons to shrinkers?
Cost
Need to purchase smaller sizes as limb size changes
Not able to use until incision is healed and sutures removed
155
What are socks used for?
May go on prior to shrinker
Different plies to accommodate changes to residual limb
156
What are disadvantages to socks?
May be creased or wrinkled and cause skin irritation
157
What are the precautions to shrinkers?
Avoid rolling edges or slipping of shrinker - could cut off circulation
158
What is the definition of suspension?
Ensures the prosthetic part will suction to the residual limb properly and effectively
159
What is suspension of transtibial residual limb?
Self-suspending
Heavier thighs may require more
160
What is the suspension of a transfemoral residual limb?
May include hip spica. Good suspension for most pt. Not adequate for obese
161
What is the benefit of hip spica?
Keep hip more ABD to prevent contractures
162
What are the pros to elastic wrap?
May be applied over post surgical dressing
Pt or family members can be instructed in wrapping as soon as wound care is no longer necessary
163
What are the cons to elastic wrap?
Need frequent wrapping
Manual coordination/dexterity
164
Would you use velcro or metal clip with elastic wrapping?
Velcro - metal clip could cause secondary injuries especially those with neuropathy
165
How to apply elastic wrap?
Do not go circumferentially
Move in figure 8 pattern
166
What are the precautions of elastic wrap?
Avoid any wrinkles or folds
Avoid adductor rol
167
Who can perform elastic wrap on pt?
Pt, family, PT/PTA, and nurse
168
What position should a transtibial amputee be in when applying elastic wrap?
Sitting
169
What position should a transfemoral amputee be in when applying elastic wrap?
Sidelying
If standing is good they could balance in standing
170
What position is NOT recommended for transfemoral elastic wrapping?
Sitting
171
What is important about positioning with amputee patient?
Improper position can result in contractures
Need full hip extension for future prosthesis
172
What are precautions of positioning with amputee patients?
Avoid elevating residual limb (hip flex contracture)
173
What position should a transtibial amputee focus on?
Full range of hips and knees
Esp EXT
174
What position should a transfemoral amputee focus on?
Full ROM in hip in ext and ADD
175
How to prevent contractures in amputee patients?
Stretching techniques
Position for prolonged mm lengthening
176
What therapeutic exercises are good for amputee patients?
OKC/CKC, progressive resistance to improve function, and gait
Core strengthening - deep abs for stability
UE resistance and sound limb resistance
Rolling, transfers, prone on elbows, prone on hands, supine on elbows, pull-ups, sitting (long and short), quadruped, kneeling, and bridging
Prep exercise for locomotion
Sitting, sit-to-stand, modified plantigrade, standing, // bar training and progression
CV conditioning
177
What positions are included in core strengthening for basic stabilization?
Hooklying, bridging, prone, quadruped, sitting, and standing
178
What progressions should be made with core strengthening in amputee patients?
Stable and unstable surfaces
Large simple movements to smaller more complex
One plane to multiplanar
Short lever to long lever
No weights to weights
Slow to fast speed
Relate to functional tasks
179
What 3 things do the beginning of resistive exercise training depend on?
Post-surgical dressing
Degree of post-op pain
Healing stage of incision
180
Define myodesis
Suturing of distal muscle or tendon to bone in residual limb
181
Define myoplasty
Muscle is sutured directly to other muscle, placed over end of bone
182
Which technique is preferred? Myodesis or myoplasty?
Myoplasty
183
How is TFA typically sutured?
ADD Magnus is brought across the cut end of the femur and sutured to lateral femur through drill holes
184
How is TTA typically sutured shut?
Gastroc is brought anteriorly and around tibia
185
What are the precautions of myodesis and myoplasty?
No CKC strengthening for 4-6 wks in TFA
No aggressive HS stretches for the first few weeks in TTA
186
What are the precautions in TFA myodesis?
No active ADD strength ex for 4 wks
No active ABD strength past neutral for 2 wks
No forward flex for 2 weeks
187
What positions is allowed after a myodesis or myoplasty?
Bridging
188
How do you perform transfer training/bed mobility WITHOUT prosthetic?
Scoot to get from supine to sit. Then sit EOB
Sit to stand
- Must get used to one sided WB
- Progress from AD to I
189
What should the pt be cautioned when transfer training/bed mobility WITHOUT prosthetic
Protect limb from trauma
DO NOT push on or slide the limb against chair or bed
190
What is important to work on with sitting balance?
Sitting EOB esp for TFA because no HS for balance
191
What is important to work on with standing balance?
Must get used to WB on one side
Progress from AD to I
192
How should amputee pt amb WITHOUT prosthesis?
Crutch training preferred if safe (walker if not safe)
Need ongoing ability to amb w/o prosthesis
193
How should a B amputee manage w/c?
Only option
TFA may use w/c for certain activities.
Consider anti-tip bars for w/c to compensate for lack of LE weight
194
Define temp prosthesis
Basic socket and pylon to allow early amb on two legs
195
What is another term for pylons?
Connectors
196
When is temp prosthesis fitted?
When wound is healed
197
What are the pros of temp prosthesis?
More effective than elastic wrap to shrink residual limb
Can help eval pt rehab potential
Can use to return to more active life
Those who cannot afford a definitive prosthesis can use temp one to amb
198
What are the cons to temp prosthesis?
Special training to fabricate temp socket
Need ongoing skin care checks and limb care as size of residual limb changes
199
What are contraindications for prosthetics?
Significant depression
Significant dementia
Significant cardiopulm disease
B amputees who are unable to transfer independently or don pants independently
200
Define the liner
Covering
Not necessarily moisture wicking
201
How often should you change the sock?
At least 1x/day
202
What is important to do with the shrinker?
Change out to prevent excess stretching
203
What are the different socket interfaces?
Liner/lock - low activity
Suction - medium activity
Vacuum - high activity
204
What are the main components of a prosthetic?
```
Shank
Pylon
Socket
Suspension system
Liner
Shrinker
Sock
Elastic wrap
```
205
What components of the prosthetic does a transtibial amputee need?
Require suspension and shank
206
Define Syme's Amputation
Amputation at the level of ankle joint and the heel pad is reserved
207
What is allowed with Syme's Amputations?
Allow WB without prosthesis
208
Define SACH
Solid ankle cushion heel
209
Define SAFE
Stationary attachment flexible endoskeleton
More M-L motion at hindfoot
210
Define Carbon Copy II
Energy storing/releasing
211
Define Seattle Foot
Energy storing/releasing
212
Define Flex-Foot and Springlite Foot
Band of carbon fiber acting as a leaf spring for more energy for running and sports
213
What motions do a Single Axis Foot allow?
DF/PF
214
What motion does a Multi-Axis Foot allow?
Triplanar ROM
215
What are the two types of shank?
Exoskeletal and Endoskeletal
216
Define an exoskeletal shank
Rigid material, shaped to simulate the anatomical leg
217
Define endoskeletal shank
Often a central aluminum pylon
218
What are sockets of a prosthesis?
Made to disperse contact and load throughout residual limb
Assist in venous return
Provide tactile feedback
Relief over bony prominences
219
What are patellar-tendon bearing sockets?
Prominent indentation over patellar tendon
220
What are the knee unit components?
Axis system
Friction mechanisms
Extension aid
Stabilizers
221
Define axis system
Single axis or polycentric linkage
222
Define friction mechanisms
Constant friction or variable friction
223
Define extension aid
Elastic webbing on anterior knee or internal extension aid
224
Define stabilizers
Alignment, manual lock, or friction brake
225
What are the characteristics and functions of transfemoral sockets?
Total contact
Distribute load
Reduce pressure
Assist in venous return
Prevent distal edema
Enhance sensory feedback
Flexible plastic allows for feedback from external objects
226
What is a quadrilateral socket?
Emphasize loading on gluteal muscles, sides of thigh, and ischial tuberosity
227
What are ischial containment sockets?
Narrow M-L width
Walls cover the ischial tuberosity, WB on the sides and bottom of limb
228
What are common problems with the fit of sockets?
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Too big
Too small
Too tight
Too loose
Rotation/twisting
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229
What are consequences of improperly fitted sockets?
Skin breakdown
230
What are the top two causes for pediatric amputations?
1. Congenital limb deficiencies
| 2. Acquired limb deficiencies
231
What are congenital limb deficiencies?
Occurs in utero
All or part of the bone fails to develop
232
Define amelia
Entire bone or segment is missing
233
Define hemimelias
All or part of bone is missing longitudinally
234
Define phocomelia
Absence of proximal segment of limb
235
Define amniotic band syndrome (ABS)
Common cause of congenital amputations
Believed to occur secondary to fetus getting entangled or ruptured amniotic bands
Typically sporadic and not hereditary
236
What occurs during acquired limb deficiencies?
May occur secondary to trauma, vascular disease, tumors, infections, or burns
Twice as many amp from trauma vs disease
May be partial or complete removal of limb
237
What are the interventions for pediatric amputations?
Surgery
Therapeutic - limb prep, exercise, functional training for age level, prosthetic training, and education
238
What are general intervention rules for peds?
For UE - prosthetic wear can occur as early as 3 months - helps child to continue with developmental skills
Components should match child development phase
239
What is the main cause of adult or adolescent UE amputation?
Trauma
240
What are the two most common UE amputations?
Transhumeral and Transradial
241
What are the three levels to transhumeral amputation?
Very short above elbow
Standard above elbow
Long above elbow
242
What are the three levels of transradial amputation
Very short below elbow
Short below elbow
Long below elbow
243
What interventions occur in the post-surgical phase of UE amputation?
Residual limb care
Residual limb wrapping
Skin desensitization and prep for prosthetic
244
What are common PT interventions for UE amputations?
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Strengthening
ROM
Functional training
Control training
ADLs
Task specific training
Don/doff
Integration of device into daily life
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245
What are the basic components to UE amputation prosthetic?
Socket
Suspension
Control - cable system
Terminal device
246
Define terminal device
End piece
Depends on amp level
247
What is a cable system?
Controlled by pt muscle movement
248
What are the types of UE prosthetics?
Cosmetic
Body powered
Myoelectric (battery powered)
Hybrid
249
What is a cosmetic UE device?
Lightest
Least functional
Provide simple aid in balance and carrying
Simple in use
Easy to maintain
Passive function
250
What is a body powered UE device?
Most durable
Operated by a harness system and controlled by specific body movements
Medium weight
Conventional device
Least appealing in appearance
251
What is a myoelectric UE device?
Heaviest
Battery powered
Controlled by EMG signals during mm contractions
Reduced harness system
Grip force up to 20-30 lbs
Cosmetically appealing
252
What is a hybrid UE device?
Combines body power and external power
253
What are the two types of hybrid UE devices?
Excursion to elbow/battery powered TD
Excursion to TD/battery powered elbow
254
What is an excursion to elbow/battery powered TD Hybrid UE device?
Body power controls elbow, battery powered controls TD (stronger pinch)
255
What is a excursion to TD/battery powered elbow?
Battery controls elbow, body power controls pinch (weaker pinch)
256
What is a recreational or adaptive UE device?
Customized for specific function or recreational activity
Available for activities such as skiing, golf, fishing, construction work, shooting pool, playing guitar, and more
257
What is the function of the lymphatic system?
Transport lymph from periphery to venous system to maintain fluid balance
Immune function, to help protect body from infection
258
Where does lymph come from?
Originate in blood plasma
Travels to capillaries from Aa
Some fluid diffuses out of blood circulation into tissue
259
Where is lymph found?
90% of fluid is returned via venous system
Remainder contains proteins and by-products (lymph) returned to circ system via lymph system
260
What is lymph made of?
Protein, immune cells, fat, and waste products from cellular processes
261
What is the lymphatic system?
Network of tubes
Drain protein rich lymph from tissues
Returned to blood via subclavian vein
262
Where is lymph filtered?
Spleen, thymus, and lymph nodes
263
Where is lymph located?
All parts of the body EXCEPT CNS and cornea
264
Where does lymph travel through?
Tissue - lymph caps - pre-collectors - collector vessels - branches - nodes - trunks - subclavian veins
265
What is the function of lymph nodes?
Phagocytosis and direct lysis
266
What are the components of lymph nodes?
B and T lymphocytes
267
Define lymphatic loads
What goes back into the blood via lymphatic system after being cleaned by nodes
268
What are the components of the lymphatic loads?
Protein
Water
Long chain fatty acids
Cells - metabolic waste, bacteria, cancer cells, dust, and foreign material
269
What are the two parts of the lymphatic system?
Superficial system and deep system
270
What is the function of superficial system?
Drain skin and subcutaneous tissue
271
What is the function of the deep system?
Drains muscles, bones, joints, and viscera
272
What happens if deep system is damaged?
Fluid may overflow into the superficial system
273
Where does the lymphatic system drain in the R upper quadrant?
Empties into R lymphatic duct and then into R subclavian vein
274
Where do the LE drain into?
Cisterna chyli and then thoracic duct
275
Where does the L upper quadrant and trunk drain into?
Directly to thoracic duct
276
Where does the thoracic duct drain into?
L subclavian vein
277
What occurs during the filling phase of lymph transport?
Pressure outside lymph caps is greater than inside
Walls open
Fluid moves into lymph cap
278
What occurs during the emptying phase of lymph transport?
Pressure outside and inside are equal
Walls close
Open valves to pre-collectors
Pumps in pre collectors and propels fluid to venous system
279
What are the fluid dynamics of lymph?
Colloid osmotic pressure
Ultrafiltration
Reabsorption
Balance b/t intravascular and interstitial volumes depending on pressure
280
Define ultrafiltration
When blood capillary pressure is GREATER than COP plasma protein
281
Define reabsorption
When blood capillary pressure is LESS THAN COP plasma protein
282
When does a pathology occur in the lymph system?
System overloaded with too much fluid or not enough functioning capillaries/collectors
Lymph accumulates in interstitium
Proteins degrade and lead to inflammation
283
Define lymphedema
Transport malfunction - accumulation of protein-rich fluid in the interstitial tissues
Results in symptoms of swelling and edema
Valvular incompetence
May progress to inflammation - fibrosis
Environment ripe for infection
284
What is the process of lymphedema?
Lyphostasis - high protein edema - accumulation of immune cells - fibrosclerosis - proliferation of adipose tissue
285
Pathophysiology of lymphedema
Valve incompetence - accumulation of fluid - constant inflammation - creation of fibrotic state of tissues - macrophages become ineffective
286
What is primary lymphedema?
Caused by a condition that in congenital or hereditary
Malfunction of lymph nodes or vessels at birth
287
What is the most common type of primary lymphedema?
Hypoplasia - fewer lymph vessels and are smaller than normal
288
What is secondary lyphedema?
Caused by injury to one or more components of the lymph system
289
What are the common causes of secondary lymphedema?
Surgery/radiation therapy for breast cancer
Liposuction
Hernia repair
Crush injuries
Chronic venous insufficiency
Disuse (CRPS)
Filariasis
290
What is filariasis?
Tropical disease caused by filarial worm
Most common worldwide
291
What are the highest incidences of lymphedema?
Breast cancer and post prostate surgery
292
What is Stage 0 of lymphedema?
Reduction in lymph transport
May feel heaviness/achiness
No increase in volume
293
What is stage 1 of lymphedema?
Protein-rich edema present
Measurable in volume
Soft and doughy
Pitting edema
Edema reversible
294
What is stage 2 lymphedema?
Increased volume
Tissue fibrosis
Positive Stemmer's sign
Less pitting
Tissue is stiffer
295
What is Stage 3 lymphedema?
Fibrosclerosis, hyperkaratosis, papillomatosis
May have less edema than stage 2
296
Define papillomatosis
Benign tumors form along aerodigestive tract
297
What kind of data collection should you take with lymphedema?
Anthropometrics - girth and volumetrics
ROM and strength
Pain
Sensation
Pitting scale
Skin texture, hyperkeratosis, fibrosis
Wounds
Functional mobility and independence
298
What does 1+ on the pitting scale?
Identation barely detectable
299
What does 2+ mean on pitting scale?
Slight indentation
Returns to normal withing 15 sec
300
What does 3+ mean on pitting scale?
Deeper indentation
Returns within 30 sec
301
What does 4+ mean on pitting scale?
Indentation lasts for more than 30 sec
302
Define Stemmer's Sign
Difficulty in picking up skin fold on 2nd toe in clearly swollen set of toes
303
What are the types of skin texture in edema?
Brawny
Woody
Lobular
304
What functional mobility and ADLs should you focus on with lymphedema?
Pain/heaviness/feeling of fullness
Weight
Balance
May lead to deficits of skills and mobility
305
What are the goals of PT in pt with lymphedema?
Educate pt and caregivers on self-management and protection
Reduce edema to enable fitting pt with compression
Successful long term edema control
306
What is part of treatment of lymphedema?
No cure
Daily management
Complete decongestive therapy
307
What is complete decongestive therapy?
Skin and nail care
Manual lymph drainage
Multi-layer compressive bandaging
Remedial exercises
308
What are the two treatment phases of lymphedema?
Intensive phase
Self-management phase
309
What is part of intensive phase of CDT?
Skin and nail care - treat and/or prevent secondary infection
MLD - light skin stretch only
Compression (limb wrapping) - bandages
Decongestive exercises
310
What is important in skin and nail care for someone with lymphedema?
Edema stretches pores of skin so bacteria can enter and lymph can leak out
Be careful of any break in skin
311
Why is lymph more prone to infections?
Bacteria thrive on the stagnant protein-rich lymph
Can spread quickly
312
What is part of meticulous skin and nail care for lymphedema?
Use mild emollients and lotions
Low pH soaps and lotions - maintain normal acidic levels of skin
Wash the tissue gently and thoroughly with warm (NOT HOT) water
Never share washcloth or towel - change out each wash
Remove all soap with thoroughly rinsing
Dry skin by patting and thoroughly - can use hair dryer on very low setting
Moisturize skin with low pH lotion
Protect against sunburn
313
Why is low pH moisturizer important?
Help restore normal protective bacteria
Help skin retain elasticity to avoid cracks/breaks
314
What is manual lymph drainage?
Additional training needed
Feel fluid move out of involved area into healthy tissues
315
What are the effects of MLD?
Increase lymph transport capacity
Increase lymphangion contractions
Redirect lymph flow
Mobilize excessive lymph fluid
316
What is the technique of MLD?
Proximal to distal
Session for 40-90 min
Most effective when used with compression
317
What is contraindicated with MLD?
Those with renal failure, CHF, DVT, acute infections or pregnancy
318
How do you apply compression for lymphedema?
Use short stretch bandages
Apply over cotton padding
Low resting pressure/high working pressure
More rigid materials provide higher working pressure
Apply with greatest pressure distally
319
What are the effects of compression?
Decrease ultrafiltration
Increase tissue pressure
Increase efficiency of mm pump
Prevent refilling of decongested limb
Break-up scar and CT deposits
Support tissues that have lost elasticity
320
How to use a pneumatic compression pump?
Recommended 30 sec compression to 5-10 sec rest
Pressure 45 mmHg (UE)
Pressure 60 mmHg (LE)
Considered multichambered
321
What are the precautions of pneumatic compression?
Impaired sensation
Pain, redness, and numbness
Lymphatic vessel dilation
Increased swelling
Changes in skin texture
322
What are the contraindication of pneumatic compression?
Brachial plexus injury
Radical breast surgery with radiation
Bilateral mastectomy
After pelvic surgery
Primary lymphedema
Edema in abdomen
ABI <0.8
DVT
Infection in limb
Malignancy
Ongoing radiation
Renal or cardiac insufficiency
Uncontrolled HTN
323
What are the effects of decongestive exercises?
Increase lymphangiomotorcity
Improve lymphatic and venous return via increased action of mm pump
Breathing exercises increase volume of lymph transported via thoracic
324
What is lymphangiomotoricity?
Lymph angions have an autonomic contraction frequency of 10-12 contractions per min at rest - increases with speed of lymph fluid flow
325
How to incorporate exercise/breathing in lymphedema?
Mod exercise and avoid overuse
Gradually build strength
Rest 20-30 min b/t MLD ad exercising
Including deep abdominal breathing before and after every exercise program
Warm up and cool down
Wear compression bandage during exercise except when in water
326
What are the precautions of exercise with lymphedema?
No tight restrictive clothing
Exercise in a slow, controlled manner
Decrease number of reps or stop if pain increases
Watch for overheating
Keep hydrated
Stop exercise with signs of increased swelling or pain
After exercising rest and elevate limb for 15-20 min
327
What is part of self-management phase in lymphedema?
Pt performs own skin care
Apply custom-sized compression during daytime
Apply compression at night
Exercise while wearing compression
328
What are lymphatic insufficiencies?
Due to chronic venous insufficiency or undiagnosed primary/secondary lymphedema
329
What can exacerbate lymphatic insufficiencies?
Trauma
Surgical intervention
Needle sticks
Taking BP on affected limb
330
What is best for lymphedema treatment?
Early intervention
Can use MLD and bandaging or MLD alone
331
When will pt be fitted for compression stocking/sleeve?
When the extremity has been evacuated
332
What is the most beneficial intervention during acute/intensive phase?
MLD
333
What indicates need for a new socket?
When pt has to use 15 ply socks
334
What does PDC stand for and what does it relate to?
Physical demand category and relates to FCE and overall FCE goals
