Exam
What are the top 2 reasons a patient doesn't use their prosthetic long term?
Comfort and function issues
What is the first step during a prosthetic check out?
Checking the skin: for redness, pain, edema, wounds, scar management, liner fit
Skin check: assess for redness, irritation, areas of excessive pressure, abrasions/blisters
What is the PROMIS outcome measure used for?
Assesses pain interference with people who have a prosthetic
If the ground reaction forces is set posterior to the knee, what moment will the knee have?
What about if it set anterior to the knee?
Posterior= Flexion moment
Anterior= Extension moment
What factors contribute to poorer outcomes post amputation? (there are 4)
Smoking, comorbidities, psychological functioning, pain
What is the second step in a prosthetic check out?
Check the prosthesis: look at alignment while prosthetic is off the patient
T/F: those with a traumatic etiology walk faster than dysvascular etiology.
TRUE
What is the OPRO outcome measure used for?
patient reported mobility assessment
What are some potential consequences of a short toe lever arm on a transtibial prosthetic?
Anterior alignment of the socket
Would cause a rapid movement posterior causing knee instability
What are some exam components that should be included with a patient who has a prosthetic?
Screens- esp skin
MSK; joint mobility, ROM, Edema, strength, pain
Neuro: motor control, sensation, proprioception
Functional Mobility
Cognition
Check out components
What is the 3rd step in the prosthetic check out?
Check the prosthetic while patient is standing
- ask about comfort
- look at knee stability, pelvis orientation and checking to see if pylon is vertical
- floor and shoe make even contact
- no tissue roles around trimline
- total contact of prosthesis on limb
- suspension is maintained when foot leaves floor
T/F: Energy efficiency of gait INCREASES as amputation level INCREASES
FALSE: energy efficiency of gait DECREASES as amputation level INCREASES
What is the difference between the AmpPro and the AmpNOPro?
AmpPro: assesses with prosthetic on
AmpNOPro: assesses without the prosthetic on
What are some potential consequences of having a long toe lever arm on a transtibial prosthetic?
Posterior alignment of the socket
Client moves from initial contact to foot flat quickly which causes a rapid movement of GRF anteriorly
What are the 6 big skin problems with prosthetics?
Ulcers, irritation, cysts, callus, neg. pressure hyperemia, verrucous hyperplasia
What is included in the 4th step of the prosthetic check out?
- is it comfortable
- any flaring of posterior trimline?
- is the residual limb forced out of socket excessively?
What kind of outcome measures are the OPUS, PROMIS, OPRO and Houghton Scale?
Patient reported- subjective
Which way is a person's COM shifted if they have a right side LE amputation?
To the left
What are some patient causes for excessive knee motion with a transtibial prosthesis?
quad weakness, hip flexion contracture shoe heel, pain, spasticity
What are 2 considerations to keep in mind when looking at stride length and walking speed in patients with prosthetic limbs?
Walking speed and stride length are usually lower in people wearing prosthesis compared to normal
Decreased walking speed= increased energy expenditure
What is included in the 5th step of a prosthetic check out?
Observe the patient walking with prosthetic
- is there any deviation?
- is it amputee or prosthetic cause?
What kind of outcome measures are the AmPro, AmpNOPro and CHAMP?
Objective measures
External: force of body weight acts through the line of gravity
Internal: muscles, ligaments, bones, counteract the external forces
What are some prosthetic causes of excessive knee motion with a transtibial prosthesis?
socket flexion, heel cushion