Prosthetic Management and Training

Question 1

T or F: we have the most evidence for the prosthetic training phase

Answer 1

T: but evidence prior to the use of a prosthetic is limited

Question 2

are LE or UE amputations more common?

Answer 2

LE

Question 3

T or F: all patients with amputation receive a prosthetic

Answer 3

F: those who do will need training

Question 4

Are transfemoral or transtibial amputees more likely to be successful ambulators

Answer 4

TTA

Question 5

why are UE amputations more common in NC than in some other states

Answer 5

high rates of farming and industrial work

Question 6

are below knee or above knee amputations more common

Answer 6

below knee

Question 7

most common age range for amputation

Answer 7

45-84

Question 8

are amputations more common in males or females

Answer 8

males

Question 9

what factors that have strong support for predicting walking ability after a lower limb amputation (4)

Answer 9

• amputation level
• age
• physical fitness
• comorbidities

Question 10

what are two things you can use as early indicators for walking ability following LE amputation

Answer 10

1 - baseline barthel index (ADLs)
2 - ability to stand on intact limb or in tandem

Question 11

3 clinical assessments associated with walking ability in amputees

Answer 11

1 - 2 minute walk test
2 - one leg balance on unaffected limb and tandem
3 - functional reach

Question 12

temporary prosthesis can be used once…

Answer 12

surgical incision is healed (10-14 days to 8 weeks post-op)

Question 13

what is the good thing about temporary prosthesis?

Answer 13

the socket can be changed easier which is good because at this point the residual limb size is not stable

Question 14

definitive prosthesis is not used until…

Answer 14

the residual limb is stable for 8-12 weeks

Question 15

what are 2 amputee specific tools to measure pain

Answer 15

1 - prosthesis evaluation questionnaire or the SF 36 health survey
2 - trinity amputation and experience scales

Question 16

what is the major pressure tolerant area for below knee amputation

Answer 16

patellar tendon and soft tissues around it

Question 17

how do you check pressure intolerant areas

Answer 17

is it blanchable?
does skin color return to normal in 10 minutes?

Question 18

what is the most common skin condition with amputations?

Answer 18

contact dermatitis

Question 19

itchy, raised, circular area on the distal end of a residual limb caused by suction being applied to the end of the limb

Answer 19

verrucous hyperplasia

Question 20

how is folliculitis usually treated?

Answer 20

topical or systemic antibiotics

*common here because it’s hot

Question 21

xerosis

Answer 21

dry skin

Question 22

if your patient has an abscess what should you do

Answer 22

refer to PCP

Question 23

lack of hip _______ can cause LBP. Why?

Answer 23

extension
b/c you anterior/posterior tilt your pelvis to compensate

Question 24

prosthetics can accommodate for less than ___ to ____ degrees of hip extension

Answer 24

15-25
but impacts weight shift

Question 25

what are 4 important variables you should look for in regards to activity limitations

Answer 25

1 - hip ext ROM and strength 2 - symmetrical step length 3 - age 4 - single leg balance

Question 26

what is a functional closed kinetic chain hip extensor exercise you can do for amputees

Answer 26

single leg bridge on a bolster *can do similar exercise for abductors

Question 27

T or F: leg length is important in amputees

Answer 27

T: leg length asymmetry can lead to increased anterior tilt and less hip extension

Question 28

doing sit to stand or stand to sit amputees often shift to...

Answer 28

their intact side

Question 29

TTA and TKA have _______ muscle activation in the spinal and abdominal muscles

Answer 29

increased

Question 30

T or F: falling and fear of falling are pervasive among amputees

Answer 30

T

Question 31

what are additional assessments you should complete with amputees? (3)

Answer 31

1 - donning and doffing prosthetic (standing and sitting) 2 - check prosthetic fit and footwear 3 - gait

Question 32

what test is the amputee version of a TUG test

Answer 32

the L test

Question 33

prosthetic training goals for pts post amputation

Answer 33

1 - build tolerance for prosthetic wear 2 - safety in gait and functional activities 3 - progress to higher level activities 4 - progress the vocational, leisure and sporting activities

Question 34

variables that play a role in prosthetic prescription (5)

Answer 34

1 - medical history 2 - PLOF and CLOF 3 - body build and type 4 - ROM 5 - availability of support at home

Question 35

who can order a prosthesis in order to be reimbursed

Answer 35

medical doctor *at least the doctor has to sign off on what prosthesis wants

Question 36

if your pt is on hemodialysis what may they need in their prosthesis

Answer 36

socket with removable insert to allow for changes in residual limb size

Question 37

if your pt has hemiplegia what may they need in their prosthesis

Answer 37

high socket trim lines or thigh corset suspension for increased knee stability

Question 38

if your pt is very active what kind of prosthetic foot may they need

Answer 38

energy storing

Question 39

if your pt is obese what may they need in their prosthesis

Answer 39

supracondylar cuff with auxillary fork strap

Question 40

if your pt works outdoors what may they need in their prosthesis

Answer 40

exoskeleton prosthesis

Question 41

how many K levels are there? what do they do?

Answer 41

4 dictate what kind of device you will get

Question 42

K-0 level

Answer 42

wheel chair user

Question 43

K-1 level

Answer 43

- household ambulator - has ability to use prosthesis for transfers or ambulation on level surfaces in the home

Question 44

K-2 level

Answer 44

- community ambulators - can traverse low level environmental barriers (curbs, stairs, uneven surfaces) - one cadence

Question 45

K-3 level

Answer 45

- can modify cadence based on environment and can traverse most environmental barriers - may be active in low level athletic activities

Question 46

k-4 level

Answer 46

- child, active adult, athlete - abilities exceed basic ambulation skills

Question 47

how do you determine K level

Answer 47

- based on amp pro score - higher score = higher k-level

Question 48

socket

Answer 48

contains residual limb

Question 49

rotator

Answer 49

allows you to rotate device without rotating hip (crossing legs)

Question 50

pylon

Answer 50

replaces the lower leg

Question 51

K1 foot (2)

Answer 51

1 - solid ankle cushioned heel 2 - single axis

Question 52

K2 foot (2)

Answer 52

1 - solid ankle flexible endoskeletal 2 - multiaxial ankle mechanisms

Question 53

K3 foot (2)

Answer 53

1 - multiaxial ankle mechanisms 2 - dynamic response (energy storing) *usually carbon fiber

Question 54

what kind of foot allows you to accommodate for ramps and different shoe types (heels)?

Answer 54

microprocessor

Question 55

T or F: you can wear different shoe types with prosthesis

Answer 55

F:unless it is a microprocessor foot you have to wear a same or very similar shoe

Question 56

3 fit and alignment principles for prosthesis

Answer 56

1 - increase residual limb weight bearing capacity (total contact!) 2 - maintain mediolateral stability in midstance 3 - encourage knee flexion in stance

Question 57

suspension

Answer 57

how the limb is kept on the prosthesis

Question 58

3 options for TTA suspension

Answer 58

1 - neoprene sleeve 2 - straps 3 - roll on "gel" liners

Question 59

Pin and shuttle locks make it easy to get the prosthesis on but what is the problem

Answer 59

they are hard to align

Question 60

In a TTA prothesis, plumb line from midsocket should fall 1/2 inch _______ to mid heel

Answer 60

lateral

Question 61

Two main types of TFA sockets

Answer 61

1 - quadrilateral 2 - ischial containment *also new HiFi socket

Question 62

where do you weight bear with a quadrilateral socket

Answer 62

ischial-gluteal

Question 63

with a TFA, socket the femur needs to be in slight ___________

Answer 63

adduction

Question 64

what TFA socket is harder to fit?

Answer 64

ischial containment, but once you get it to dit it is easier to control

Question 65

TFA suspension options (5)

Answer 65

1 - silicone sleeve 2 - silesian belt (common here) 3 - hip joint and pelvic band 4 - suspenders 5 - roll on "gel" liner

Question 66

axis options for prosthetic knees

Answer 66

single polycentric

Question 67

stability options for prosthetic knees

Answer 67

manual weight activated

Question 68

friction options for prosthetic knees

Answer 68

constant variable

Question 69

fluid control options for prosthetic knees

Answer 69

pneumamtic hydraulic

Question 70

_________ axis and ______ locking knees are good for people who are less active

Answer 70

single manual

Question 71

____ axis and ______ locking knees are good for people who are active

Answer 71

polycentric weight-activated

Question 72

stability at the knee is determined by these two things

Answer 72

1 - individual's ability to control the knee using muscular power 2 - TKA line

Question 73

TKA line

Answer 73

trochanter to knee to ankle

Question 74

are you more stable if TKA line is anterior or posterior to the knee

Answer 74

anterior

Question 75

the _________ the heel the more stable the knee

Answer 75

softer

Question 76

keel

Answer 76

forefoot

Question 77

the ______ the keel the more stable the knee

Answer 77

stiffer