Prosthetic Management

Question 1

what is the importance of K levels

Answer 1

determines what prosthetic they get and is important for insurance companies

Question 2

basic description of K2 level

Answer 2

community ambulator

Question 3

basic description of K1 level

Answer 3

household ambulator

Question 4

basic description of K3 level

Answer 4

community ambulator with variable cadence

Question 5

basic description of K4 level

Answer 5

ambulation exceeds basic skills; exhibits high impact stress and energy levels

Question 6

what is the most commonly used prosthetic for transtibial amputations

Answer 6

lock and pin

Question 7

things to be aware of for donning and doffing

Answer 7

make sure its reflected all the way back to avoid blistering and skin breakdown
check alignment of the pin

Question 8

what are the warning signs of poor skin care

Answer 8

change in color of skin lasting more than 15-20 min
red, irritated or open area on skin
increased pain or edema
calluses or dry cracked skin

Question 9

wearing schedule of prosthesis

Answer 9

day 1-2: 30 min am and pm
day 3-4: 1 hour am and pm
day 5-10: 2 hors am and pm
day 11-14: full day but remove at lunch and dinner for skin checks
day 14: full time; recommended to check fit once a day

Question 10

cleaning of inserts and sockests

Answer 10

inserts should be wiped out daily with mild soap and warm water with time to dry. inspect for cracks or damage

sockets should be cleaned out at least weekly by wiping with warm water and towel. clean at night to dry

Question 11

what incorrect foot placement is more concerning in the sagittal plane

Answer 11

when the foot is placed lateral to the socket. placement tends to cause a rotation of the socket that creates friction and rubbing

Question 12

what side of the UE should be removed from the parallel bars first during weight shifting activities

Answer 12

remove the sound side UE first and keep the prosthetic limb as the stance leg

Question 13

what muscles are active to stabilize the body during prosthetic stance activities

Answer 13

hip extensors and hip AB

Question 14

what key element are you working on during initial ambulation in the parallel bars

Answer 14

working on facilitating pelvic rotation. important to restore this by using manual cuing for normal gait pattern

Question 15

what type of gait pattern on the stairs does someone with a transfemoral amputation usually have

Answer 15

step to pattern

Question 16

what type of gait pattern on the stairs does someone with a transtibial amputation usually have

Answer 16

step over step pattern

Question 17

what is the purpose of loading the prosthetic toe

Answer 17

to achieve knee flexion

Question 18

which side of the body would be able to achieve more arm swing

Answer 18

more arm swing on the sound side due to the fact that there is less rotation on the prosthetic side

Question 19

what happens to the knee when there is posterior displacement of the socket over the foot

Answer 19

the knee is extended for too long because the foot is too far forward

Question 20

reasons for why the knee remains extended along with corrections

Answer 20

• foot is too anterior (move foot posteriorly to correct)
• foot is too PF (move foot into DF to correct)
• excessive use of knee extensors or weak quads (strengthening and gait training to correct)

Question 21

what occurs with anterior displacement of the socket

Answer 21

excessive knee flexion

Question 22

causes and corrections of knee flexion

Answer 22

• foot too posterior (move foot anteriorly to correct)
• foot too DF (move foot into PF)
• weak knee extensors (quad strengthening to correct)

Question 23

with what type of amputation does lateral trunk bending always occur

Answer 23

hip disarticulation

Question 24

causes and corrections for lateral trunk bending

Answer 24

prosthesis too short (measure leg length to correct)

RL pain (evaluate fit and need for additional socks to correct )

weak RL ABductors (abductor strengthening exercises to correct)

Question 25

what is a correction for wide based gait

Answer 25

move the foot medial

Question 26

what is a simple correction for a narrow based gait

Answer 26

move the outset foot laterally

Question 27

how is the direction of a whip determined

Answer 27

named for what the heel is doing

Question 28

why would vaulting occur

Answer 28

in transfemoral if the prosthesis is too long

Question 29

why would circumduction occur

Answer 29

in transfemoral if the prosthesis is too long, poor suspension or difficulty flexing the knee

Question 30

cause of unequal stride length

Answer 30

fear of putting weight through the prosthetic limb

Question 31

causes and corrections of lateral trunk bending in TRANSFEMORAL

Answer 31

``` weak AB (strengthen abductors) high medal wall of prosthesis (modify prosthesis ) short prosthesis (lengthen prosthesis) AB contracture (stretch AB) instability (balance training) foot outset too far (move foot medially) ```

Question 32

causes and corrections of pistioning

Answer 32

socket too loose (add socks, assess fit) inadequate suspension (assess suspension) improper donning (patient education)

Question 33

causes and corrections of circumduction

Answer 33

``` long prosthesis (shorten it) excessive PF ( move foot into DF) weak hip flexors (strengthen hip flexors) abductor contracture (stretch abductors ) ```

Question 34

what motion at the hip is crucial for knee stability in stance

Answer 34

hip extension

Question 35

causes and corrections of whips

Answer 35

improper alignment of knee joint in relation to the socket (realign knee)

Question 36

what is the knee joint set in for a medial whip to occur

Answer 36

external rotation

Question 37

what is the knee joint set in for a lateral whip to occur

Answer 37

internal rotation

Question 38

why do people with transfemoral amputations need hip extension

Answer 38

controls knee extension

Question 39

how would a silesian bandage be a helpful correction for whips

Answer 39

coming above the waist can help control the rotation from below

Question 40

possible causes of instability at the knee

Answer 40

malfunction of stance control knee weak hip extensors hip flexor contractuure excessive DF

Question 41

What occurs during an audible snap

Answer 41

terminal knee extension before heel strike

Question 42

possible causes of terminal swing impact

Answer 42

insufficient knee friction | fear of buckling causes pt to forcefully extend the hip

Question 43

possible causes of foot rotation at heel strike

Answer 43

``` stiff heel cushion malrotation of the foot poor hip control weak hip rotators socket too loose ```

Question 44

possible causes of uneven step length

Answer 44

hip flexion contracture excessive knee friciton pain on prosthetic limb prosthesis too long

Question 45

what side of the body will have a shorter step length and why

Answer 45

the sound side will have a shorter step length because they don't want to stand for a long time on the prosthetic side

Question 46

what is the main cause of uneven arm swing

Answer 46

not enough pelvic rotation

Question 47

possible causes of drop off at terminal stance

Answer 47

inadequate DF resistance foot positioned too far posterior foot too DF stride too long on sound leg

Question 48

possible causes of lordosis (excessive trunk extension)

Answer 48

hip flexor contracture weak hip extensors and abdominals excessive anterior pelvic tilt inadequate socket flexion

Question 49

possible causes of excessive heel rise

Answer 49

insufficient knee friction | forceful hip flexion to ensure adequate knee extension and cleareance

Question 50

causes of excessive knee flexion in early stance

Answer 50

SACH heel too firm foot set in too much DF knee axis too anterior to hip and ankle severe hip flexor contracture

Question 51

causes of pisitioning

Answer 51

socket too loose inadequate suspension improper donning

Question 52

what does pisitioning do to the limb

Answer 52

lengthens the limb

Question 53

what gait deviations are more common for transfemoral

Answer 53

``` vaulting circumducted gait unequal stride length lateral trunk bending abducted gait hip hiking whips excessive heel rise pistioning lordosis drop off decreased arm swing foot rotation at heel strike terminal swing impact ```

Question 54

what gait deviations are more common for transtibial

Answer 54

``` knee hyperextension excessive knee flexion lateral trunk bending wide based gait delayed knee flexion ```