Limb deficiency Flashcards by Alexander Lee

What is the most common cause of limb deficiency

60% congenital

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Limb buds appear in the ________ week of embryonic development and are completed by the _____ week

4th week 7th week

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What are the two philosophies for UE deficiencies

Sit to fit vs task specific

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Children who wear 2-4 prostheses may not have _________________

enough exposed skin to disperse heat adequately

note: also since child has less limbs the have less total surface of skin to disperse heat

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A Aitken classification of PFFD (proximal femoral focal deficiency)

acetabulum present

femoral head present

shorter femur

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B Aitken classification of PFFD (proximal femoral focal deficiency)

well defined acetabulum

unossified femoral head

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C Aitken classification of PFFD (proximal femoral focal deficiency)

no femoral head

poorly defined acetabulum

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D Aitken classification of PFFD (proximal femoral focal deficiency)

extremely short or absent femur (no acetabulum)

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What are the surgical and non-surgical options for PFFD (Proximal femoral focal deficiency)

Lengthening of femur (if hip and knee are stable)

Boyd/symes amputation

Van Nes Rotation Osteotomy

Knee fusion

Epiphysiodesis to create shorter residual limb for prosthesis (need femur to be 5cm shorter than contralateral sie)

No surgery, with use of extension prothesis

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Child has no acetabulum and severely shortened femur

Aitken D

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Child has well defined acetabulum but unossified femoral head

Aitken B

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What is the most common gait deviation with PFFD?

Posterior and lateral trunk lean during stance phase due to poor strength of abductors and extensors

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What are the clinical findings of PFFD

Hip instability

Malrotation

Insufficient proximal mm

Limb length deficiency

Limb usually in flexion abd er

70-80% have fibula deficiency

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What are the 3 types of tibial deficiencies

Complete absence of tibia, no quads
Proximal tibia well formed, quadriceps present
Presence of distal tibia only

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How do tibial deficiencies present

Abnormal articulation of knee and ankle

Equinovarus foot deformity

Leg length discrepancy

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Tibial deficiencies also come with what problems

No ACL

Anterior bowing

Varus/valgus deformities

Revisions needed during growth

Missing 1st or 2nd rays

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For tibial deficiencies it is crucial to _____

Check for sufficient quadriceps to drive amputation level

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What surgery do children get if tibia is absence

Knee disarticulation

(Removal of any bones below knee and attaching the foot to the femur)

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What are the 2 classifications of fibular hemimelia

Type 1: hypoplastic fibula

Type 2: absent fibula

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How will fibular hemimelia present

May be missing lateral toes

Anterior medial bowing common with dimple

May have short femur

ACL deficiency or absent

Varus or valgus deformities as they grow

Missing lateral 2 or 3 ray of foot

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What surgeries will a child with fibular hemimelia get

Boyd - removal of foot but keep the calcaneus for WB surface
Or

Symes - removal of entire foot

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A child using a prosthetic might need what for the other foot

Shoe lifts

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At what age can you provide a prosthetic for a congenital deficiency

Study These Flashcards

Once a child can pull to stand (8-12 month)

Why is stump wrapping preformed prior to prosthetic use

Study These Flashcards

If not preformed, the residual limb will shrink once ambulation begins and they will not fit in the socket anymore

How should you teach a child to desensitize their amputation site

“Love on your leg/arm” Use massage of different pressures Different temps Different textures

You require atleast _____ of hip ext for terminal stance stride

5-10

T or F: patients need to stretch up until they get their prosthetic

F, they need to continue stretching even after they get their prosthetic

Pt needs full knee ext for ____ And neutral adduction in order to ____

Stance stability In order to get prosthesis under body for normal BOS

What should patients with BKA (below knee amputation) avoid

Putting pillow under knee Sitting in wheelchair with knee always flexed

Pts with traumatic injuries with a AKA (above knee amputation) are at risk for ______ contractures We should encourage sleeping ____

Hip flexion, ER, abduction contracture Encourage sleeping prone

What is the overall progression for gait training w a prosthetic

Stance -> stride -> stepping

What treatments can we use to target weight shifting and control in SLS

moving tennis ball under foot Step ups (maybe with targets?)

What kind of facilitation works best for gait training younger children who can’t follow instructions

PNF

Will children plateau in PT?

Only if you’re not challenging them enough Children should never plateau

Boys are _____ as likely as girls to suffer a TBI

Twice

What are the 3 most common causes of infant TBI

Falls Near drowning Abuse

Why will physicians opt to diagnose children with CP even if they’re not a classical case of CP

Because it will allow the children to have more benefits from insurance

Kids under _____ years that have an insult to the brain can be diagnosed with CP

Under 3

How well do children recover from concussion

20% in 24 hours 64% in 1-7 days 11% in 1-4weeks 2% in greater than 1 month

Children r more vulnerable to concussions/TBI

Not a question, just know it!

What secondary impairment might follow a TBI

5-20% of children who sustain a TBI will develop heterotopic ossification

The prognosis for acquiring new skills is _____ the younger the child has a TBI

Worse

Consideration of ____ Is key for successful intervention in TBIs

Rancho level

For children with rancho 1-3 what do we do?

Maintain ROM, skin integrity Provide sensory stimuli

How can we set up an activity to break up tone

Set up the activity that makes it impossible for them to go into those positions

If a child has extension tone where do we need their toy to be to help break up tone

In front of them where they must bend over to encourage flexion and avoid extension

______ is key, as well as therapist demonstration, when a patient is unable to follow commands

Toy/activity placement

For rancho 4-6, what are our priorities

Provide structure and prevent overstimulation Engage in task specific training Emphasize safety Relaxation techniques Encourage mobility Work on attention to task

For rancho 7-10 what are our goals

Allow for increase independence safe community reintegration

____ is key for SCI patients

Education and family being on board They can regress quickly if they aren’t following HEP

During tasks do we want a large or narrow BOS

Narrow It’s better for muscle activation

When working with patients, how many impairments do we want to address with each treatment

As many as possible!!

When would we want to do part-task practice

If a pt is extremely limited with one specific part of a task and it’s significantly slowing down their progress on other aspects

What’s the difference between traditional therapy and Activity Based Restorative therapy ABRT

ABRT activated the NS above and BELOW level of lesion Higher intensity Includes patterned movements Restores lost function instead of compensates Minimizes compensatory devices

Where do we want to apply facilitation to a patient

At the point of failure (the weakest muscles) Whether it be quads, glutes, anterior tib, or trunk

Limb deficiency Flashcards

(56 cards)