Special Populations Flashcards
(51 cards)
1
Q
BILATERAL AMPUTATIONS
A
BILATERAL AMPUTATIONS
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)
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.
4
Q
AS compared to unilateral amputations, bilateral concepts remain the same.
- _____ fitting
- Avoiding complications
- Preservation of the _____ joint is critical.
A
- early
- knee
5
Q
Bilateral amputee progression is significantly ______ and we see an _______ in energy expenditure.
A
- slower
- increase
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
7
Q
Is a bilateral transtibial or unilateral transfemoral amputee more energy effecient?
A
bilateral transtibial
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
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….
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”
11
Q
When can “Stubbies” be useful?
A
Early in progression of a transfemoral amputee.
12
Q
What are some rehab considerations for bilateral transfemoral amputees?
A
- Balance
- Transfers
- W/C skills
- Falling/recovery
- UE strength
- Gait
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
14
Q
What gait characteristics do we expect with bilateral amputees?
A
- Wide BOS with decreased speed
- Typically use AD
- Very taxing
- Community barriers
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
16
Q
PEDIATRIC AMPUTEES
A
PEDIATRIC AMPUTEES
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
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
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
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.
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
Pediatric Main Takeaways:
- Rehab _____>________ and ____ use.
- Educate parents on ________, device __________, and ________/________.
- Make therapy age appropriate.
- Encourage use.
- Encourage adaptive sports.
- Be realistic.
- ROM>strength, AD use
| - skin care, device function, donning/doffing
26
HIGH-LEVEL AMPUTEE REHAB
HIGH-LEVEL AMPUTEE REHAB
27
What is the goal for high-level amputee rehab?
- Allow for participation in physical exercise and/or sports.
- Want to maintain or enhance physical conditioning gained during functional rehab.
28
What are the responsibilites of the rehab team with high-level amputee rehab?
- injury prevention
- motivation
- education
29
What are some things to have before progressing to high-level rehab?
- Acceptable gait (walking and running)
- Stable volume
- Skin condition
- Baseline health
- Reason for amputation
30
What is the ideal team when working with our patient?
- Patient
- Coach
- Prosthetist
- Strength and Conditioning Coach
- PT
31
What is the role of the prosthetist?
- 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
What is the role of the coach?
- Must understand muscle function, imbalance, and injury risk concepts.
- Produce a tailored and individualized program.
- Careful monitoring.
- Frequent communication.
33
What is the role of the strength and conditioning specialist?
- 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
What is the role of the PT?
Basic assessment - determine readiness (seek medical clearance as necessary).
35
What are the parts of the readiness assessment?
- Gait, CV fitness, core strength, balance, proprioception, muscle imbalances.
- History of previous participation.
- History of previous injury,
- Frequent communication.
36
What PT interventions are important when going to high-level?
```
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
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.
- athlete
- overactive
- HS, quad
38
As far as cardiovascular impact goes, amputees have a lower _____ max and __________ thresholds than able bodied individuals.
- VO2
| - anaerobic
39
Amputees already have non-optimal biomechanics. What may happen if we ask them to perform some kind of mechanical overload?
- compensatory mechanisms
| - over-reliance on sound limb
40
What are some compensatory mechanisms we may see?
- 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
How do we reduce the risk as far as overload goes?
High energy demand + less muscle to generate force = INCREASED RECOVERY TIME
42
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.
- compensatory
| - sport specific
43
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.
- sport
| - fatigue
44
- What are common gaits to see in prosthetic running?
| - What amputations is it even more common in?
- circumduction and vaulting
| - TFA and bilateral
45
Why are circumduction and vaulting common?
- Length of the prosthetic.
| - Difficulty maintaining posture due to limb length differences.
46
What are the 4 steps of prosthetic running?
1. ) Trust the prosthesis
2. ) Hip extension
3. ) Stride symmetry
4. ) Arm carriage
47
Prosthetic Sprinting- An Advantage?
- _______ symmetry during start
- __________ phase requires continuous adaptation by the runner.
- >200m = ______
- Bilateral implications
- decreased
- acceleration
- turns
48
Prosthetic vs able-bodied sprinters disadvantages?
- 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
Prosthetic cycling advantages?
- can be started earlier than running
- may not require specialized prosthesis
- low impact
- can allow for balance loss
50
Prosthetic cycling common modifications?
- pedal systems
- shortened, wider crank arm
- recumbent bikes
51
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.
- team
- overload
- "normal"
- do not
