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DPT 621 > PT Management of Prosthetics > Flashcards

PT Management of Prosthetics Flashcards

(106 cards)

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1
Q

what are the phases of care in prosthetics?

A

pre-surgical
post-surgical
pre-prosthetic
prosthetic prescription
prosthetic exam/training

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2
Q

what two factors can pose a large barrier to prosthetics?

A

available ROM

positioning

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3
Q

who makes the adjustments on prosthetics?

A

the prosthetist

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4
Q

who are the team members for prosthetics management?

A

PT
OT
prosthetist
physician
psychologist

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5
Q

what are the goals of prosthetics management?

A

smooth and efficient gait

ADL performance

acceptance of body weight on each leg at initial contact

single leg balance on each LE

symmetry of stance time

spinal stability during swing and stance phase

symmetrical step length

adaptation to various environments

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6
Q

how do we create spinal stability?

A

by minimizing pelvic tilt and frontal plane compensations

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7
Q

what are the PT roles in prosthetics management?

A

address the non-prosthetic issues (or skin integ)

contribute to prosthetic prescription

examine the prosthesis

facilitate prosthetic acceptance

instruct pt in donning, use, and maintenance of the prosthesis

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8
Q

what is sock ply?

A

the ability to modify acceptance of a limb into a prosthetic

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9
Q

t/f: sock ply is not something PTs have much to do with

A

false, this is something we WILL change and have to be able to teach the pt

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10
Q

what things do we want to look at in the examination for prosthetics?

A

AROM/PROM of BLE

length of residual limb

strength of all limbs and trunk musculature

sensory exam

skin/integ inspection

memory

circulation

aerobic capacity

fxnal exam

psychosocial awareness

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11
Q

why do we want to look at the length of the residual limb?

A

bc it will impact the suspension systems

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12
Q

what is an important sensory system fxn to consider with prosthetics? why?

A

proprioception at the knee bc it will impact knee stability

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13
Q

when should we do a skin inspection with prosthetics?

A

before and after treatment

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14
Q

why do we want to include memory in our exam?

A

bc they will need to be able to learn new info

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15
Q

why do we want to consider circulation and anthropometric findings in our exam?

A

bc they will impact the sock fit and management

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16
Q

what is included in a fxnal exam?

A

transfers

STSs

bed to/from WC

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17
Q

what are the two broad categories of analysis we want to complete at the eval?

A

static analysis
dynamic analysis

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18
Q

what type of analysis involves looking at how the pt looks in standing w/ and w/o the prosthesis?

A

static analysis

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19
Q

what type of analysis involves looking at pts during gait?

A

dynamic analysis

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20
Q

where should we begin the static analysis for TTA?

A

in the parallel bars to attempt equal WBing

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21
Q

what should we assess for during static analysis in TTA?

A

comfort

AP, ML alignment by slipping paper under prosthetic shoe if there is bad WBing

pelvic postition/level

piston action

sitting position and posterior brim on the popliteal fossa

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22
Q

in severe cases, we may use a ____ _____ to normalize pelvic position <1/2 in

A

shoe lift

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23
Q

what is the piston action?

A

the vertical motion of the socket when the pelvis is elevated

the residual limb moving in/out of the socket with weight shifting

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24
Q

in the piston action, the residual limb should slip <____in

A

1/4

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25
how do we measure the slip with the piston action?
with chalk on the person
26
t/f: we are almost always going to see some form of "gait compensation" in pts using prosthetics
true
27
t/f: no prosthesis restores sensation, skeletal continuity, muscles integrity, or full body weight
true
28
what are some common prosthetic causes of gait compensations?
poor fitting socket (likely due to fluctuant edema)-big one prosthetic misalignment malfunctioning components improper height of prosthesis - big one inappropriate donning inappropriate shoes
29
what should be the focus during the dynamic analysis of TTA?
the action of the knee of the amputated limb during stance phase
30
what does too much knee flexion of the residual limb in stance in TTA dynamic analysis indicate?
the socket is too far anterior relative to the foot
31
what does too much knee extension of the residual limb in stance in TTA dynamic analysis indicate?
the socket is too far posterior relative to the foot
32
what does too much knee flexion of the residual limb in early stance in TTA dynamic analysis indicate?
the heel cushion is too firm
33
t/f: problems often start at the knee and move to the pelvis and trunk
true
34
during late stance, what are some prosthetic causes of early knee flexion/ "drop off"?
shoe heel is too high insufficient PF DF stop is too soft socket is too anterior socket is excessively flexed
35
during late stance, what is an anatomical cause of early knee flexion/ "drop off"?
flexion contracture
36
during late stance, what are some prosthetic causes of delayed knee flexion/ "perception of walking uphill"
shoe heel is too high excessive PF DF stop is too stiff socket is too posterior socket is insufficiently flexed
37
during late stance, what are some anatomical causes of delayed knee flexion/ "perception of walking uphill"
extensor spasticity
38
what is involved in TTA static analysis (off patient)?
checking for skin redness or breakdown on the residual limb checking the height of the anterior wall vs the posterior brim
39
do prosthetics with TFAs or with TTA tend to be more uncomfortable? why?
prosthetics with TFAs tend to be more uncomfortable bc they go into the sensitive area of the groin and buttock
40
the more ___ the knee bolt, the most stable the knee is
posterior
41
what should we examine in the TFA static analysis?
flesh roll above the socket/peripheral pressure and pain maintenance of extension of the hip proper location for the adductor longus and ischial tub in the quadrilateral socket WBing on the ischial tub on the "shelf" of the quadrilateral socket sitting ability
42
in the TFA dynamic analysis, if there is abduction, what are some possible prosthetic causes?
prosthesis is too long hip joint is abducted lateral wall is inadequately adducted medial wall is too sharp or too high
43
in the TFA dynamic analysis, if there is abduction in stance, what are some possible anatomical causes?
abduction contracture weak abductors lateral/distal pain adductor redundancy instability
44
what is probably the most common compensation/deviation we will see for lateral displacements?
circumducting gait
45
in the TFA dynamic analysis, if there is circumduction in swing, what are some possible prosthetic causes?
prosthesis too long knee unit is locked friction is insufficient suspension is inadequate the socket is too small the socket is too loose the foot is PFed
46
in the TFA dynamic analysis, if there is circumduction, what are some possible anatomical causes?
abduction contracture poor knee control
47
in the TFA dynamic analysis, if there is lateral bend in stance, what are some possible prosthetic causes?
prosthesis is too short lateral wall is inadequately adducted medial wall is too sharp or too high
48
in the TFA dynamic analysis, if there is lateral bend in stance, what are some possible anatomical causes?
abduction contracture weak abductors hip pain instability short amputation limb
49
in the TFA dynamic analysis, if there is fwd flexion in stance, what are some possible prosthetic causes?
knee unit is unstable walker or crutches are too short
50
in the TFA dynamic analysis, if there is fwd flexion in stance, what are some possible anatomical causes?
instability
51
in the TFA dynamic analysis, if there is medial/lateral whip at heel off, what are some possible prosthetic causes?
socket contour is faulty knee bolt is externally/internally rotated foot is malrotated prosthesis is donned in malrotation
52
in the TFA dynamic analysis, if there is medial/lateral whip at heel off, what are some possible anatomical causes?
with load-dependent friction unit with fast pace
53
in the TFA dynamic analysis, if there is foot rotation at heel contact, what are some possible prosthetic causes?
heel cushion is too stiff
54
in the TFA dynamic analysis, if there is heel rise in early swing, what are some possible prosthetic causes?
friction is insufficient extension aid is slack
55
in the TFA dynamic analysis, if there is terminal impact in lateral swing, what are some possible prosthetic causes?
friction is insufficient extension aid is taut
56
in the TFA dynamic analysis, if there is terminal impact in lateral swing, what is a possible anatomical cause?
forceful hip flexion
57
in the TFA dynamic analysis, if there is vaulting in swing, what are some possible prosthetic causes?
prosthesis too long knee unit is locked friction is insufficient suspension is inadequate the socket is too small the socket is too loose the foot is PFed
58
in the TFA dynamic analysis, if there is vaulting in swing, what is a possible anatomical cause?
fast pace
59
in the TFA dynamic analysis, if there is hip hike in swing, what are some possible prosthetic causes?
prosthesis too long knee unit is locked friction is insufficient suspension is inadequate the socket is too small the socket is too loose the foot is PFed
60
in the TFA dynamic analysis, if there is hip hike in swing, what are some possible anatomical causes?
weak DFers PF spasticity pes equinus weak hip flexors
61
in the TFA dynamic analysis, if there is uneven step length, what are some possible prosthetic causes?
socket is uncomfortable socket is inadequately flexed
62
in the TFA dynamic analysis, if there is uneven step length, what are some possible anatomical causes?
hip flexion contracture instability
63
what is involved in prosthetic training?
donning exercises to stretch and strengthen balance and coordination training
64
what do we have to teach pts about donning?
the correct application frequent inspection correct sequencing of componentry/suspension/socks etc
65
what exercises should we include for stretching and strengthening?
hip flexor stretching isometric multi-directional hip strength
66
where should we start balance coordination training?
in the parallel bars with open hands
67
what things should be included in balance and coordination training?
static balance with level pelvis and shoulders weight shifting to the prosthesis mirror feedback progression to ML, sagittal, and rotary control in dynamic exercises
68
what are the goals of strengthening?
to improve weakness found in the exam to maximize strength and endurance of ms to decrease energy expenditure of the prosthesis
69
what ms groups do we target in strengthening?
glutes !!! abdominals back extensors quads
70
t/f: we must obtain a close fit bw the sock and the limb with a prosthetic
true
71
what is involved in pt Ed with prosthetics?
proper fit WBing areas sensations
72
what is the proper alignment of the patella in a TTA prosthetic?
the patella should sit right above the trim line
73
if there is a decreased limb volume, what will happen to the alignment of the patella in the prosthetic?
there will be increased contact from it sinking into the prosthetic
74
if there is a increased limb volume, what will happen to the alignment of the patella in the prosthetic?
the patella will sit too far up
75
t/f: there should be no distal pressure on the residual limb in a proper fitting prosthesis
true
76
if there is distal pain of the residual limb in the prosthesis what could this mean?
that they're bottoming out and sinking into the prosthetic too much
77
what is involved in postural control in the pre-prosthesis phase?
sitting balance AD training transfers
78
what is involved in postural control in the prosthetic training phase?
core stability equilibrium responses (adaptive and reactive) control of new COM
79
what are the main two components of skin care in prosthesis care?
proper hygiene edema prevention
80
what problems related to prosthetic shear or friction may occur when wearing the prosthesis?
abrasions blisters edema bacterial infections boils
81
t/f: the skin and sock must be washed regularly and dried to keep them clean
true
82
why should cleansing products or perfumes containing alcohol be avoided on the amputated area?
to avoid drying and cracking of the skin
83
t/f: edema is exacerbated in higher temps
true
84
if edema is not prevented, what may result?
discoloration blisters ulcers
85
what are some general edema management strategies?
stretching compression using elastic bandages pneumatic or cooling compression lymph node massage HVPC
86
in severe cases of edema, what may be used for management?
meds like anti-inflammatories or injections of corticosteroids
87
t/f: PTs must consider the types of componentry in training bc some skills are specific to certain prosthesis components
true
88
t/f: we must maximize time training with an AD
false, we must maximize training w/o external support
89
t/f: a RW will have sig impacts on the transverse plane movts
true
90
gait training is used to improve...
quality and efficiency of gait
91
t/f: we should avoid overuse do the intact LE in gait training with a prosthesis bc it can lead to numerous MSK problems in the knee and back most commonly
true
92
what are the goals of gait training?
to improve spatiotemporal and kinematics symmetry and bioenergetics of gait
93
what are some options we have available for gait training with prosthesis?
treadmill, VR, bodyweight support, and gaming (ie Wii Fit)
94
in prosthetic gait training, there is emphasis on what?
symmetric performance
95
do we want greater load through the intact or residual limb in gait training with a prosthesis?
through the intact limb
96
in prosthetic gait training, the primary focus is on strengthening what ms?
HS
97
do we want to work on step length in prosthetic gait training?
yes
98
do we want to work on changing directions in prosthetic gait training?
yes
99
do we want to work on inclines/declines in prosthetic gait training?
yes
100
do we want to work on ability to adapt to changes in surfaces in prosthetic gait training?
yes
101
what is involved in fall management?
teaching the pt how to safely fall and get back up
102
what is involved in advanced gait training?
changes in environments (obstacles, variable surfaces, picking up objects, carrying items) steps and ramps
103
with descent, why does the pt always have to place the prosthesis on the edge of the step?
lack of DF
104
t/f: TFA will need to strategically lock/unlock the knee pending scenarios like walking down a steep hill
true
105
what are the self-reported outcomes we can use in prosthesis users?
prosthetic evaluation questionnaire locomotor capabilities index ABC
106
what are the fxanl outcome measures we can use in prosthesis users?
TUG 6MWT 2MWT AMPRO and AMnoPRO

DPT 621 (16 decks)

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