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S3- Amputation And Prosthetics > Special Populations > Flashcards

Special Populations Flashcards

1
Q

BILATERAL AMPUTATIONS

A

BILATERAL AMPUTATIONS

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2
Q
  • Simultaneous bilateral limb loss is __________.

- What is the major cause of bilateral lower limb loss?

A
  • infrequent

- dysvascular disease (usually effects both limbs, rehab is heavily impacted)

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3
Q

What is an important thing to consider for patients progressing from unilateral to bilateral amputation as far as success goes?

A

Successful unilateral prosthetic use undicator of bilateral success.

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4
Q

AS compared to unilateral amputations, bilateral concepts remain the same.

  • _____ fitting
  • Avoiding complications
  • Preservation of the _____ joint is critical.
A
  • early

- knee

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5
Q

Bilateral amputee progression is significantly ______ and we see an _______ in energy expenditure.

A
  • slower

- increase

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6
Q
  • Bilateral amputees have an increased fear of falling, what are some reasons for this?
  • How do we address this?
A
  • BOS reduced, decreased proprioception
  • lack of anterior support
  • emphasis on transfers and trunk control
  • teach how to fall and recover
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7
Q

Is a bilateral transtibial or unilateral transfemoral amputee more energy effecient?

A

bilateral transtibial

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8
Q

Bilateral Transtibial Components:

  • Tend to have _____ foot/ankle on each limb.
  • Absorb ______.
  • Protect the limb.
  • Suspension (decrease _______, _____/_____ preferred)
A
  • same
  • shock
  • decrease pistoning, vacuum/suction preferred
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9
Q

What are some rehab considerations for bilateral transtibial amputees?

A
  • Gait
  • Balance
  • Falling
  • W/C and AD use
  • UE strength
  • Progress as normal….
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10
Q

Bilateral Transfemoral Components:

  • Reliable ______/______ phase control from the knee unit.
  • Stability from the _____/_____.
  • _______ containment socket.
  • ________ suspension with appropriate liner.
  • “_________”
A
  • stance/swing
  • ankle/foot
  • ischial
  • suction
  • “Stubbies”
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11
Q

When can “Stubbies” be useful?

A

Early in progression of a transfemoral amputee.

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12
Q

What are some rehab considerations for bilateral transfemoral amputees?

A
  • Balance
  • Transfers
  • W/C skills
  • Falling/recovery
  • UE strength
  • Gait
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13
Q
  • Transfemoral and transtibial amputees tends to have a _______ prognosis than bilateral transfemoral amputees.
  • The emphasis should be on the _______ side (strength and prosthetic components) and should involve optimization of the __________ side when possible.
A

-better

  • transtibial
  • transfemoral
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14
Q

What gait characteristics do we expect with bilateral amputees?

A
  • Wide BOS with decreased speed
  • Typically use AD
  • Very taxing
  • Community barriers
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15
Q

Bilateral LE Main Takeaways:

  • Gait with bilateral prostheses _______ energy expendture.
  • Even if ambulatory ALL B LE amputees need to have profecient / skills.
  • Although slower, general progression is still ________
  • Increased likelihood of _____ deviations.
A
  • increases
  • W/C
  • the same
  • gait
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16
Q

PEDIATRIC AMPUTEES

A

PEDIATRIC AMPUTEES

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17
Q

What are the different challenges that pediatric amputees face that are different than adult amputees?

A
  • Motor development and milestones
  • Learning
  • Psychosocial
  • Skeletal
  • Neuromuscular
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18
Q
  • The basic components of pediatric prosthetics are the _____ but ________.
  • They require ______ durability, and thus have _____ choice.
A
  • same but smaller

- more durability, less choice

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19
Q

With pediatric amputees, we need to accomodate growth and use.

  • Grade School = __-__ months
  • Teenagers = __-__ months
  • Heavy day to day use and vigorous play
  • Socket fit
A
  • Grade School = 12-18 months

- Teenagers = 18-24 months

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20
Q

A lot of time a prosthetist will build a much bigger socket than needed for a child, why?

A

To allow for removal of socks/liner instead of having to get a new socket while growing.

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21
Q

What is a rotationplasty?

A

Knee joint is removed, lower leg is turned and attached to femur; ankle now functions as a knee.

22
Q

When is a rotationplasty used?

A

Used for tumors of the distal femur or proximal tibia, typically in peds.

23
Q

A rotationplasty prosthetic is similar to a __ prosthesis. There is no phantom limb and they have a ______ return to function.

A
  • TT

- quick

24
Q

With a rotationplasty:

  • PF = knee ________
  • Df = knee _________
A
  • extension

- flexion

25
Q

Pediatric Main Takeaways:

  • Rehab _____>________ and ____ use.
  • Educate parents on ________, device __________, and ________/________.
  • Make therapy age appropriate.
  • Encourage use.
  • Encourage adaptive sports.
  • Be realistic.
A
  • ROM>strength, AD use

- skin care, device function, donning/doffing

26
Q

HIGH-LEVEL AMPUTEE REHAB

A

HIGH-LEVEL AMPUTEE REHAB

27
Q

What is the goal for high-level amputee rehab?

A
  • Allow for participation in physical exercise and/or sports.
  • Want to maintain or enhance physical conditioning gained during functional rehab.
28
Q

What are the responsibilites of the rehab team with high-level amputee rehab?

A
  • injury prevention
  • motivation
  • education
29
Q

What are some things to have before progressing to high-level rehab?

A
  • Acceptable gait (walking and running)
  • Stable volume
  • Skin condition
  • Baseline health
  • Reason for amputation
30
Q

What is the ideal team when working with our patient?

A
  • Patient
  • Coach
  • Prosthetist
  • Strength and Conditioning Coach
  • PT
31
Q

What is the role of the prosthetist?

A
  • Designs prosthetic that is relevant to the increased demand of the amputee athlete.
  • Modifies componentry to maximize function and reduce injury risk.
  • Frequent communication.
32
Q

What is the role of the coach?

A
  • Must understand muscle function, imbalance, and injury risk concepts.
  • Produce a tailored and individualized program.
  • Careful monitoring.
  • Frequent communication.
33
Q

What is the role of the strength and conditioning specialist?

A
  • Develops optimal conditioning for the specific sport or activity.
  • Target all aspects of strength, power, stability, endurance, balance, and CV fitness.
  • Monitoring.
  • Frequent communication.
34
Q

What is the role of the PT?

A

Basic assessment - determine readiness (seek medical clearance as necessary).

35
Q

What are the parts of the readiness assessment?

A
  • Gait, CV fitness, core strength, balance, proprioception, muscle imbalances.
  • History of previous participation.
  • History of previous injury,
  • Frequent communication.
36
Q

What PT interventions are important when going to high-level?

A 
Basic strength and conditioning
-UE/LE
-Injury prevention
-Coordination with CSCS
Core stability
-improved power output
-provide for a stable base
-sport specific
Gait training
-identify deviations
-to correct or not?
-running assessment
37
Q

Muscle Strength and Imbalances (TTA):

  • Intact limb is stronger than amputated leg (less difference in amputee _________)
  • Hip musculature can be ___________ (increased energy absorption and generation at the hip, also compensates for lack of PF)
  • Eccentric ______ power is increased in sound limb, but eccentric _______ power was greater in amputated leg.
A
  • athlete
  • overactive
  • HS, quad
38
Q

As far as cardiovascular impact goes, amputees have a lower _____ max and __________ thresholds than able bodied individuals.

A
  • VO2

- anaerobic

39
Q

Amputees already have non-optimal biomechanics. What may happen if we ask them to perform some kind of mechanical overload?

A
  • compensatory mechanisms

- over-reliance on sound limb

40
Q

What are some compensatory mechanisms we may see?

A
  • Asymmetrical overload of sound limb during gait
  • Knee total work less on amputated side vs intact (TTA)
  • Increased hip energy generation on amputated side
  • All increased if the RL is painful!
41
Q

How do we reduce the risk as far as overload goes?

A

High energy demand + less muscle to generate force = INCREASED RECOVERY TIME

42
Q

Strengthening:

  • Address ___________ movements through rehabilitation efforts first.
  • Strengthening should be ____________ (core strength and stability)
  • Principles of strengthening same for able bodied individuals (w exception of increased recovery time).
  • Increase load appropriately.
A
  • compensatory

- sport specific

43
Q

Endurance:

  • Can take on a variety of forms.
  • ______ specific.
  • Principles the same for able bodied individuals.
  • Consider that the amputated limb may _______ faster than the sound limb or the CV system.
A
  • sport

- fatigue

44
Q
  • What are common gaits to see in prosthetic running?

- What amputations is it even more common in?

A
  • circumduction and vaulting

- TFA and bilateral

45
Q

Why are circumduction and vaulting common?

A
  • Length of the prosthetic.

- Difficulty maintaining posture due to limb length differences.

46
Q

What are the 4 steps of prosthetic running?

A
  1. ) Trust the prosthesis
  2. ) Hip extension
  3. ) Stride symmetry
  4. ) Arm carriage
47
Q

Prosthetic Sprinting- An Advantage?

  • _______ symmetry during start
  • __________ phase requires continuous adaptation by the runner.
  • > 200m = ______
  • Bilateral implications
A
  • decreased
  • acceleration
  • turns
48
Q

Prosthetic vs able-bodied sprinters disadvantages?

A
  • Increased demand in muscle work
  • Asymmetrical stride length, stride time, and impact loads
  • More energy expenditure (debatable)
  • Increased mechanical work on sound limb
  • Change in mechanics
  • ~10% reduction in force
49
Q

Prosthetic cycling advantages?

A
  • can be started earlier than running
  • may not require specialized prosthesis
  • low impact
  • can allow for balance loss
50
Q

Prosthetic cycling common modifications?

A
  • pedal systems
  • shortened, wider crank arm
  • recumbent bikes
51
Q

Amputee Athletes Main Takeaways:

  • ____ effort.
  • Risk of ________, there must be a balance to avoid considerable setback.
  • Needs to be finished with “_______” rehab before progressing, have a mature limb.
  • Running blades ______ increase performance.
  • Unlimited options for athletic involvement.
A
  • team
  • overload
  • “normal”
  • do not

S3- Amputation And Prosthetics (10 decks)

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