Rehab Exam 3 Review Flashcards
(52 cards)
1
Q
Parts of AFO (4)
A
- Foundation
- Ankle Control
- Foot Control
- Superstructure
2
Q
AFO: Foundation
A
- Basic foundation: Shoe, Plastic (insert) or metal (stirrup) component
3
Q
AFO: Insert
A
- Plastic insert or metal insert or foot plate
- Provides control for foot
- Helps with donning
- Lightweight
4
Q
AFO: Stirrup
A
- Riveted through shoe shank
5
Q
AFO: Ankle Control
A
- Limits DF, PF, or both
- Solid Ankle- Foot Orthosis: Trim lines anterior to malleoli, controls DF and PF
- Hinged (articulated) solid-ankle foot orthosis: Metal joint that resists DF and PF; has spring that sets
- Posterior Leaf Spring: Early stance, pt applies force, upright bends backward slightly; Swing, plastic recoils forward to lift foot
- DF Assist with Steel Spring (articulated): Coil spring compresses in stance, rebounds during spring
- PF Resistance: Posterior stop limits PF; prevents PF spasticity
6
Q
AFO: Ankle Control (Affect on knee position and control)
A
- Excessive DF = Increased knee flexion and decreased knee stability
- Excessive PF = Increased knee extension and increased knee stability
7
Q
AFO: Foot Control
A
- Medial-Lateral Control
- Lateral leather strap (pulls ankle to keep from going valgus or varus)
- Contoured edges
- Stiffness of material
8
Q
AFO: Superstructure
A
- Uprights, shell, band, brim
- Height provides longer lever arm = increased stability
- Positioned below fibular head
- Double metal upright
- Plastic trim lines narrow or wrapped for stability
- Spiral AFO: Controls but does not limit motion in all planes
- Carbon, graphite or titanium uprights
- Floor reaction control: solid AFO with anterior band near knee which directs forst posteriorly
- Patellat-tendon-bearing brim
- Tone-reducing orthosis: decreased spasticity, foot plate and broad upright apply pressure on PF and invertors
9
Q
Types of locks for KAFO
A
- Offset joint
- Drop Ring Lock
- Pawl lock bail release
- Knee cap
- Electronic stance control mechanism
10
Q
KAFO: Offset Jt
A
- Pt weight falls anterior to offset jt
- Hinge placed posterior to jt
- Adv: Stabilizes knee in ext during stance; Does not interfere with knee flex during swing or sitting
- Dis: Can disengage during stair climbing or walking on ramps
11
Q
KAFO: Drop Ring Lock
A
- In standing, ring drops into place
- Most common knee control lock
- Adv: Prevents uprights from bending
- Dis: Has to be manually disengaged
12
Q
KAFO: Pawl Lock with Bail Release
A
- Unlock by pulling on posterior bail
- Adv: Can by intentionally activated by nudging against a chair
- Dis: Bulky, Can release unexpectedly against object
13
Q
WB alignment for using KAFO
A
- WB must be aligned anterior
14
Q
HKAFO: Lock used at hip joint
A
- Metal hinge
- Lock: Drop Lock (more difficult to engage for sitting
15
Q
Reciprocating Gait Orthosis (RGO)
A
- THKAFO with hips joined by a metal cable or rod
- Cable tightens and recoils to propel legs forward
- Enables patient to have reciprocating gait
- Components: Offset knee joints (more knee stability, Pre-tibial bands, Solid AFO (more control and support)
16
Q
RGO Gait
A
- Shift weight onto RLE
- Tuck pelvis by extending upper thorax
- Press on crutches
- Allow LE to swing through
- Reverse for next step
- Very rigid orthoses, holds legs because no control
17
Q
Purpose of LS Corset
A
- Increases intra-abdominal pressure
- Also decreases frontal movement
- LS Corset is not rigid; no horizontal rigid structure
- Some corsets have rigid vertical structure (stays) that help keep corset in place
18
Q
Patient position for wrapping following BKA/AKA
A
BKA (Trans-tibial) - Pt in sitting
AKA (Trans-femoral) - Pt in side-lying
19
Q
Residual limb wrapping (BKA)
A
- Elastic bandage/ace wrap
- Two 4-inch bandages, not sewn together so weave is in contra-position to each other
- Provides the best compressive forces
- Wrap in figure 8 to avoid creating tourniquet
- Fire, even pressure - distal to peoximal
- Avoid wrinkles and folds
20
Q
Residual limb wrapping (AKA)
A
- Elastic bandage/ace wrap
- Two 6-inch bandages and one 4-inch bandage
- Two 6-inch bandages may be sewn together, end -to-end, small *not bulky”seam
- 6-inch bandages applied first, followed by 4-inch bandage
- Wrap in figure 8 to avoid creating tourniquet
- Fire, even pressure - distal to peoximal
- Avoid wrinkles and folds
21
Q
Shrinkers
A
- Trans-tibial: Rolled over residual limb to mid-thigh; self-suspending (if heavy thrigh, may require suspension - garters, waist band)
- Trans-femoral: Incorporates hip spica for suspension
- Avoid rolling of edges or slipping = tourniquet
22
Q
Height of amputation
A
- The higher the amputation, the more difficult activities such as stairs and curbs will be
23
Q
Surgical considerations for amputation
A
- Longest bone length (better for use of prosthesis)
- Preserve as many jts as possible
- Vascular supply
- Skin flap (Fold skin up, or sew at site of amputation)
- Three skin flaps: Long posterior flap, skew flap, preserve max muscles
24
Q
Purpose of massage s/p amputation
A
- Increase pliabiity/softness, facilitate scar mobility, shaping of limb, edema control
25
Rigid Dressings
- IPOP (Immediate post-operative prosthesis): plaster-of-paris socket, not adjustable or removable
- RRD (Rigid removable dressings): Plaster or pre-fab plastic, may be removed for wound inspection
- Adv: Allows early WB, Reduces edema and pain, Enhances healing
- Dis: Expensive, application requires special training, must learn to use, limits examination of wound, close supervision during early healing
26
Semi-rigid Dressings
- Unna's Dressing (gauze has compound of zinc oxide, gelatin, glycerin and calamine - applied in OR); similar to ace wrap, sticks to itself as dressing is wrapped around
- Adv: Better edema control than soft dressings, promotes better healing than soft dressings, some dressing have impregnated compounds that promote healing
- Dis: May loosen, not rigid
27
Soft Dressings
- Ace wraps and shrinkers
- Adv: Inexpensive, lightweight, easily cleaned
- Dis: Poor edema control; easily slips, can cause tourniquet affect; elastic wrap requires skill to apply
- Purchasing new shrinkers as edema decreases
- Cannot use shrinkers until suture/staples removed
28
Requirements for prosthesis (?)
- Length of prosthesis
- Strength of limb/trunk muscles
- Skin condition
- Sensory function
- Pt ability to learn and retain new information
- Dimensions of amputation
- Pt aerobic capacity and endurance
- Obesity
29
Prosthetic potential
- No general rules/criteria
- Amb with 1 prosthesis, increased potential for revision
- Considerations: Cost, energy demands
- BKA/AKA: Energy, balance, strength
- BL Amp: Young, agile, strength, coordination, balance, cardio-respiratory
30
Advantages of Syme's Amputation
- Calcaneal fat pad allows pt ability to WB on end of residual limb
- Long lever arm = increased prosthetic control
- Dis: Bulky, bulbous en can cause difficulty with prosthesis
31
Parts of Transtibial prosthesis
- Foot-ankle assembly
- Shank
- Socket
- Suspension
32
Non-Articulated Feet
- Feet and lower shank are one section (no joint)
| - SACH, SAFE, Carbon Copy II, Seattle Foot, Flex foot, Springlite foot
33
SACH
- Solid Ankle Cushion Heel
- Provides small amount of medial-lateral and tranverse motion
- Several PF angles for different heights; varying heel cusions
- Absorbs shock, allows PF in early stance
- Allows hyperextension during late stance
34
SAFE
- Stationary attachment flexible endoskeleton
- Adv: Provides more medial-lateral ROM in rear foot; Allows amb on uneven terrain
- Dis: Heavy, more expensive
35
Energy Storing Feet
- SAFE, Carbon Copy II, Seattle Foot, Flex Foot, Springlite Foot
- Springy sole stores energy
- Foot bends slightly in early, mid stance, sole stores energy
- Late stance, weight transfers to opposite LE, foot recoils and returns some stored energy
36
Articulating Feet
- Metal bolt or cable joins foot and lower shank
- Motion controlled by rubber bumpers
- Rear bumper = WB on heel causes PF = stable foot flat position
- Anterior = Anterior to ankle (firm) = DF Stop = resists DF as weight transfers over foot
37
Components of Articulating Feet
- Axes: Single (permits DF, PF, toe break) or multiple (movement in all planes
- Rotators (absorbs shock in tranverse plane, prevents chafing)
- Shank (prosthetic "leg" restores length and shape
38
Shank
- Exoskeletal: Wood or rigid plastic (shaped like anatomical leg, can be tinted to match skin tone)
- Endoskeletal: Aluminum or plastic puylon covered by foam rubber (More natural appearance, can be adjusted for slight angulation)
39
Reliefs (Socket)
- Concavities
- Pressure relief of sensitive areas
- Fibular head, tibial crest, tibial condyles, anterior-distal tibia
40
Buildups (Socket)
- Convexities
- Contact of pressure-tolerant areas
- Belly of gastroc, patellar tendon, proximal-medial tibia, pes anserinus, tibial and fibular shafts
41
Supracondylar Cuff (Suspension)
- Leather strap above femoral condyles
| - Can adjust snugness with straps
42
Fork Strap and Waist Belt (Suspension)
- Add to Supracondylar cuff for more support
| - Fork strap attaches anteriorly to prosthesis
43
Rubber Sleeve (Suspension)
- Tubular; covers proximal prosthesis and distal thigh
| - Dis: Requires two strong hands, won't accommodate large tissue in residual limb
44
Distal Attachment (Suspension)
- Silicone sheath and distal pin
- Sheath clings to skin
- Pin inserts into receptacle in prosthesis
45
Brim Variants (Suspension)
- Supracondylar suspension
| - Supracondylar/Suprapatellar suspension
46
Supracondylar suspension
- Medial/lateral walls extend over femoral epicondyle; plastic wedge inserts into medial wall
- Adv: Increased M/L stability; Cosmesis of knee; eliminates strap and buckles
- Dis: Harder to fabricate; expensive
47
Supracondylar/Suprapatellar suspension
- Anterior wall extends over patella
| - Dis: High ant wall can interfere with kneeling; Prosthetic knee mroe prominent in sitting
48
Thigh Corset
- Leather or plastic corset attaches to hinges on prosthesis
- Adv: increased frontal plane stability; increased WB load distribution
- Dis: Heavier, Increased pistoning; pressure atrophy of thigh; difficult to don laces and velcro
49
Vacuum-assisted
- Pump liner and sleeve creates air-tight environment
| - Adv: Decrease edema; regulate edema fluctuation, decrease moisture accumulation; increase proprioception
50
AKA Suction Suspension
- Pressure difference between inside/outsde socket
- Socket brim fits snugly
- 1- way air release valve: distal end; residual limb expels air
51
WB occurs where in BKA prosthesis
Patellar tendon
52
AKA Socket alignment
- Total contact to distribute load, reduce edema, increase sensory feedback, assist venous return
- Slight flexion facilitates contraction of hip extensors, decrease lumbar lordosis; facilitates extension for equal step length
- Pressure tolerate for WB (posterior): glutes, lateral thighs, distal end or residual limb
- Avoid pubic symphisis, perineum
