Week 14 Prosthetic Evaluation and Management

Question 1

what do you want to look at to determine if a patient is an appropriate for a prosthesis?

Answer 1

-will the prosthesis aide in achieving functional goals
-severity of comorbidities
-mobility prior to amputation
-family demands/input
-have a candid conversation with the patient

Question 2

what are the common impairments, functional limitations or disabilities seen with amputation?

Answer 2

-decreased community access
-joint contracture
-impaired aerobic capacity
-impaired gait pattern
-impaired integ. and inadequate shape of residual limb
-impaired performance during ADLs
-residual limb pain
-edema
-difficulty with manipulation skills

Question 3

what factors contribute to the patients functional outcomes?

Answer 3

-pre prosthetic activity level
-level of amputation
-comorbidities/energy expenditures
-hip flexion contractures
-financial issues especially if no insurance

Question 4

what are some comorbidities that may affect the patient’s ability to use a prosthesis?

Answer 4

->85y/o with comorbidities have a small likelihood of successful prosthetic ambulation
-increase age and # of comorbidities = less probability with success
-PVD: high cardiac/stroke risk claudication
-COPD: limited due to increased O2 demands

Question 5

how can contractures affect the likelihood of success with a prothesis?

Answer 5

<25 degrees can usually be accommodated
-affects the ability to weight shift properly and control prothesis esp. knee flexion/extension
-severe contractures limit ability

Question 6

what are some examples of functional outcome measures used for TF amputees?

Answer 6

AMP
L test
Berg Balance
TUG
2MWT

Question 7

what are the two surgical techniques used in a TF amputation?

Answer 7

-myoplasty: deep layer: medial and lateral muscle groups sutured together; second layer: anterior and posterior muscle groups sutured together; outer layer: skin sutured

-myodesis: adductor magnus pulled medial to lateral and sutured to lateral femur; quadriceps pulled over adductor anterior to posteriorly and sutured to posterior femur

Question 8

what are the benefits of ace wrapping?

Answer 8

-inexpensive
-pt can perform
-ease of skin checks
-can modify tension for comfort if patient is hypersensitive

Question 9

what are the drawbacks of ace wrapping?

Answer 9

-difficult for some to perform
-difficult to apply appropriate pressure
-adverse skin reactions

Question 10

what position should the patient be in when wrapping the limb?

Answer 10

side lying for better control with hip neutral or slightly extended

Question 11

what functional mobility does a TF amputee need?

Answer 11

independence with bed mobility (including prone), transfers, and positioning/stretching

Question 12

how much hip extension should a TF patient have?

Answer 12

0-10 degrees

Question 12

what are the pressure sensitive areas for a TF amputee?

Answer 12

greater troch
ramus
anterior superior iliac spine
adductor tendon
distal end of the femur
inguinal fossa
pubic tubercle
surgical suture

Question 12

what are the pressure tolerant areas for a TF amputee?

Answer 12

ischial tuberosity
lateral flear of stump
medial flear of stump
anterior flear of stump
posterior flear of stump
distal end of the stump for total contact socket

Question 13

what are some factors that may affect prosthetic wear?

Answer 13

-skin issues
-distal bruising/bursa formation
-pain
-neuromas
-wear and tear/broken componentry

Question 14

what should you check when doing a TF checkout in sitting?

Answer 14

-socket suspension: pull on socket
-length of the thigh and shin matches the intact limb with knee levels at 90
-sitting comfort: posterior wall
-pt leans forward to check anterior wall

Question 15

what should you check during a TF checkout in standing?

Answer 15

-socket fit/comfort
-knee stability in stand: inability to control knee flexion
-pelvic landmarks: check levels of iliac crests
-socket contact: check brim of socket and weight shift
-adductor roll: check high in groin for excessive tissue on medial wall
-pubic ramus pressure

Question 16

what are some of the prosthetic training goals?

Answer 16

-smooth energy efficient gait (accept weight BL, balance in SLS, advance limb forward BL, adapt to environmental demands)
-increase independence with ADLs, functional mobility, recreational, and work activities

Question 17

what are the critical training elements with a TF amputee?

Answer 17

-stability BLE
-knee control
-stability on prosthesis
-prosthetic control
-proprioception
-pelvic control
-stepping
-side stepping/backward stepping

Question 18

why should you avoid using a walker with an amputee?

Answer 18

it does not allow for smooth, symmetrical gait

Question 19

energy expenditure is directly related to __ and __.

Answer 19

balance and gait symmetry