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What are the five stages of rehab?
- Prosthetic Prescription
- Prosthetic examination
- Prosthetic training
What are the 4 stages of Prosthesis training?
- 1. Donning/Doffing
- 2. Balance and coordination
- 3. Gait
- 4. Functional mobility training
What is necessary in order for successful rehabilitation?
- Realistic expectations
- Involvement of patient, family, and other caregivers
- Financial resources to service the prosthesis
What are the two types of AFOs?
- Leather and Metal
- Thermoplastic or laminated carbon fiber
What are some of the characteristics of thermoplastic or laminated carbon fiber AFOs?
- Offers good control of foot because can be adjusted specifically to each foot
- Can be modified to reduce pressure areas or changes in diameter
- Shoe must be higher on dorsum of foot to maintain orthotic inside
- Patient may wear more than one pair of shoes
What are some of the characteristics of metal and leather AFOs?
- 1) Better for bariatric patients or very active patients who require more support
- 2) Stirrup types
- a) Solid stirrup offers maximum stability
- b) Split stirrup allows patient to change shoes
What are the reasons for increased energy expenditure of a prosthesis?
- Imperfect anchorage (of a socket)
- Increased verticle movement to compensate for decreased knee flexion of prosthesis
- Loss of proprioceptive and tactile feedback (Foot-ankle assembly & transfemoral)
- Loss of ROM (Foot-ankle assembly)
- Loss of propulsion (Foot-ankle assembly)
- Muscles further from prosthetic joint (transfemoral)
Identify and explain the joint type for AFOs with static control.
- 1) Plantarflexion stop:
- a) Prevents plantarflexion during swing to prevent toe from dragging on floor
- b) prevents knee from hyperextending during stance and produces knee flexion force using early stance
- 2) Dorsiflexion stop:
- a) Person with paralyzed triceps surae (gastrocs
- and soleus) can achieve late stance for improved toe off
- 3) Solid AFO limits all ankle motion
- a) Hinged solid AFO allows slight sagittal motion
- during stance to improve foot flat
Which functional activity is first in order on the mobility spectrum?
When performing a 3 person carry, where does the strongest person support?
Head and upper trunk or midsection
Where in relation to the pt. is the clinicain who is responsible for coordinating the transfer with a sliding transfer?
At the pt.'s head to the side that the pt. is moving
When performing an assisted standing pivot transfer, the pt. should assume the full upright position before pivoting.
Who is ultimately responsible for the safety of the pt.?
Verbal commands are:
Brief and specific
Footrests and leg rests are adjustable to fit the length of a pt's...?
Supervising PT has instructed a PTA to order a w/c for and elderly pt whose S/P THA. It is critical for the PTA to order...?
A solid seat
What are the 5 cardinal rules of body mechanics?
- Do not twist
- Lift with the legs
- Use isometric contraction of the trunk muscles
- Establish an appropriate BOS (feet wide & staggered)
- Keep the load close
What are two advantages of quick release (removable) wheels on a wheelchair?
- easier storage/transport
- easier to replace worn wheels
What are 3 advantages of the fixed frame W/C?
- easier to transfer into and out of vehicle
- fewer components
What are two things a PTA must do prior to moving a pt.?
- lock wheels
- place gait belt on pt.
Describe pillow placement for a pt. in the supine position
- A pillow placed cross-ways underneath a pt.'s knees and lower legs
- Pillow under the head of the pt.
Describe the placement of pillows for proper pt. positioning in prone
- Pillow cross-ways underneath a pt.'s torso
- Pillow cross-ways under the ankles and lower leg of the pt.
What are the purpose of verbal commands during transfers?
To synchronize the actions of all participants in the transfer
What are the purposes of proper positioning for:
- integumentary: preventing ulceration as a result of pressure or friction
- musculoskeletal: preventing loss of ROM
- neuromuscular: preventing peripheral nerve impingement as a result of pressure
- cardiovascular: assist secretion elimination, breathing patterns, and blood flow
What are the goals of proper positioning? (7)
- Ensure pt. comfort
- Skin integrity by preventing ulcer development
- Maintain musculoskeletal integrity by prevening loss of ROM
- Maintain neuromuscular integrity by preventing peripheral nerve impingement
- Maintain cardiovascular/pulmonary integrity by using changes of position to assist w/ blood flow and breathing
- Provide pt. access to the environment
- Provide proper positioning for specific interventions
What are the levels of AKA?
- long transfemoral: >60% femur left
- transfemoral: 35-60% femur left
- short transfemoral: <35% femur left
What are the levels of foot amputation?
- Partial toe (any part of one+ toe)
- Toe disarticulation (at MTP joint)
- Partial foot/ray resection (resection of 3-5 MT and digits)
- Transmetatarsal (amputation though misection of all MT)
- Syme's (ankle disarticulation w/ attachment of heel pad to distal end of tibia; may include removal of malleoli and distal tib/fib flares)
What are the levels of BKA?
- Long transtibial: >50% tibia left
- transtibial: 20-50% tibia left
- Short transtibial: <20% tibia left
- knee disarticulation: through knee joint
What is necessary in order to use a prosthesis?
- Good residual limb shaping
- Good ROM, strength of residual limb
- Good balance
- Cognition for safety and care
Why is early rehab important following an amputation?
- Lower chance of contractures
- Lower chance of debilitation
- Lower chance of psychological consequences
What are the 5 reasons/causes of amputation?
- Peripheral Vascular Disease (PVD)
What are the levels of UE amputation?
- Partial finger
- Finger resection
- Ray resection
- (long, mid, short) forearm
- elbow disarticulation
- (long, mid, short) humeral
- Shoulder disarticulation
What are the levels of hip amputation?
- Hip disarticulation: amputation through hip joint, pelvis intact
- Hemipelvectomy: resection of lower 1/2 of pelvis
- Hemicorporectomy: amputation of both lower limbs and pelvis below L4-L5 level