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what is the number 1 cause for amputations?
PVD associated with smoking and DM
where would you find a disarticulation amputation?
at the joint line
where is the disarticulation for the toe?
what is the resection for a partial foot?
3rd, 4th, 5th metatarsals
what is symes?
ankle disarticulation with attachment of heel pad to distal end of tibia
what is a long transtibial?
- more than 50% of tibial length remains
what is a transtibial?
between 20-50% of tibial length remain
what is a short transtibial?
20% or less of tibia remains
what is a knee disarticulation?
amputation of the knee joint; femur remains intact
what is a long transfemoral?
- more than 60% of femur remains
what is a transfemoral?
between 30-60% of femur remains
what is a short transfemoral?
less than 35% of femur remains
what is a hip disarticulation?
amputation through the hip joint; pelvis remains intact
what is a hemipelvectomy?
- resection of the lower half of the pelvis
- ischium gone; ilium intact
what is a hemicorporectomy?
amputation of both lower limbs and pelvis below L4-5
what three things must be considered before the type of amputation is chosen?
- optimal healing
- optimal prostesis fit and function
- stabilization of major muscles
the skin flap on a residual limb must have what three qualitities?
what is a major concern after an amputation?
what are some of the factors that can influence healing after an amputation?
- premorbid conditions: DM, cardiac disease, renal disease,
what are the two phases of the postoperative program after amputation?
- phase 1: post surgical; from surgery -> fitting of prosthesis
- phase 2: prosthetic phase; learning to use the permanent replacement limb
what are some of the goals for the postoperative phase after amputation?
- I bed mob & t/f
- I with wc and self care
- demo proper residual limb positioning, bandaging and care
- mod-min A short distance gait with walker or crutches
what are the post op dressings used mainly for?
how would you instruct a patient to wrap their residual limb?
start at the top and pull down in a diagnal direction and wrap around the back in a figure 8 shape putting more tension at the bottom. Make sure to cover every inch of skin and that there are no wrinkles in the elastic.
how would a patient typically describe their phantom limb pain?
tingling, burning, itching, pressure, cramping, squeezing, shooting or burning pain
up to ______% of amputees complain of phantom limb pain
what are some other considerations to have when treating amputees?
- functional status
- emotional status
- financial status
- family support
your treatment with an amputee would include what kind of activities?
- residual limb care and wrapping
- management of contractures
- ther ex
what is the purpose of a partial foot prosthesis?
- restore as much of the foot function as possible
- simulate as much of the shape of the missing foot segment
what do transtibial and symes prosthesis have in common?
both retain the natural knee, motor and sensory function
what are the basic componets of a transtibial and symes prosthesis?
- foot-ankle assembly
what is the difference between an articulated and non-articulated prosthesis?
- the articulated has an ankle joint
- there is some movement with the nonarticulated, but there is more with the articulated which makes it better to the younger, more active populatin
why is the nonarticulated prosthesis more popular?
- lighter, more durable, more attractive
- some even fit high heel shoes
what are the 3 types foot prosthetics?
- SACH: solid ankle cushion heel
- SAFE: stationary attachment flexibe endoskeleton
- carbon copy II: funny skis
which type is the most popular foot prosthetic?
- comes in a wide array of sizes
- allows for minimal medal lateral motions
what is the differences between the SACH and SAFE foot?
the safe allows for more medial lateral motion, is heavier, and more expensive
the foot assembly is chosen with what three things to consider?
- patients age and lifestyle/activity level
- length of residual limb
what are the rotators?
- component placed above the prosthetic foot to absorb shock in the transverse plane
- protects skin from chafing
- mostly used by very active individuals
what is the shank?
sub for the leg
what are the two types of shanks?
- exoskeletal (crustacean)
- endoskeletal (modular)
why do symes prothesis not have a shank?
describe an exoskeltal shank
- made of wood or rigid plastic
- simulates the look of a lower leg
- very durable, water proof
- dont permit for changes in angulation > less prescribed
describe and endoskeletal shank
- made of central aluminum pylon
- cosmetic cover to appear like the natural lower leg
- angulation abilities, more comfort and easier to walk with
what is the socket?
receptacle where the amputated limb sits
how the socket designed?
contact all portions of the amputated limb which allows for maximal load distribution
what is a lined socket?
- foam liner that cushions the residual limb
- is removable and insulates heat
how would you make an unlined socket more comfortable?
liner socks and cushion placed at the bottom of the socket
what are the 5 different ways of suspending the prosthesis?
- rubber sleeve: need strong hands and no excessive adipose
- brim variants: supracondylar suspension
- thigh corset: increases frontal plane stability, prone to pistioning
- sheath with distal metal pin: very secure
what is the most commonly used foot with the transfemoral prosthetic?
what are the 4 main features of the knee joint replacement?
- friction mechanism
- extension aid
- mechanical stabilizer
not all knees have all 4
what is the purpose of the knee joint replacement?
- allows the patient to bend during sitting and kneeling
- allows for knee flexion during the later stance phase throughout swing phase
what is the knee axis?
connects the thigh piece to the shank
what is the most common type of knee axis?
what is the friction mechanism of the knee?
changes the knee swing by modifying the speed of knee motion during swing phase according to the walking speed
what happens if the knee friction is not modulated?
excessive knee flexion at the beginning of swing phase and vice versa
what is the extension aid of the knee?
mechanism to assist knee extension during the latter part of swing phase
Do most knee's have stabilizers?
what do the knees depend on for stabilization mostly?
what is suction suspension?
atmospheric pressure causes the socket to remain on the thigh.
what are the two grades of suction suspension?
- total: maximal control
- partial: wearer uses socks and an external suspension aid
when might you see the patient for physical therapy due to amputation?
pre amputation (if available) and post amputation
what do you examine the prosthesis for once the patient receives it?
fit and function in standing and gait
what does the prosthetic training include?
- socks and sheaths
- donning and doffing
- transfers, curbs, ramps
- pt education & skin inspection
what are the three tunics of the blood vessles?
- tunica adventitia: outer most
- tunica media: middle
- tunica intima: inner most
what are the three types of arteries?
- large elastic
- medium muscular
- small arteries and arterioles
describe large arteries
- receive blood from the ventricles and pumps it to the medium arteries
- ex: aorta
describe medium arteries
- distributing arteries
- walls consist of circular smooth muscle
- have the ablility to vasocontstrict
- ex: brachial, femoral
describe small arteries and arterioles
- have narrow lumnia and thick muscular walls
- have no name and arterioles can only be seen under a microscope
what is the difference between veins and arteries when it comes to their tunics?
tunica media is thinner in the companion veins
do veins pulsate or spurt blood when severed?
what are the three types of veins?
describe the venules
smallest veins that drain capillary beds that join similar vessles to form small veins that form venous plexuses
describe medium veins
- accompany medium arteries (which they are named after) and drain venous plexuses
- in the limbs that contain venous valves that pump blood towards the heart
describe a large vein
wide bundles of longtiduinal smooth muscle and well developed tunica adeventita
T/F: there are more arteries than veins.
T/F: the walls of veins are thinner than arteries, but veins are bigger than arteries
what are simple endothelial tubes connecting the arterial and venous circulation and are arranged in beds/networks
what is the purpose of capillary beds?
allow for the exchange of materials in the extracellular space
what is an "over flow system" for surplus tissue fluid and leaked plasma proteins in the extracellular space that is responsible for removal of debris form cellular breakdown and infection and is essential for survival?
what are the components of the lymphatic system?
lymph plexuses, vessles, nodes, lymphocytes, lymph fluid, lyphoid organs
what are lymphoid plexus?
lymphatic capillaries that origninate in extracellular space of most tissues that are formed by endothelium and are lacking a basement membrane
describe the lymph vessels
body wide network of thin walled vessles that contain valves which give lymph the beaded like appearance and they appear everywhere blood capillaries are found
what is lymph fluid
"blood plasma of the immune system"
what are the lymph nodes?
small mases of lymphatic tissue along the course of the lymph vessles that filters lymph on its way to the venous system
what are circulating immune cells?
what are the lymph organs?
- organs that produce lymphocytes
- thymus, red bone marrow, spleen, tonsils
what is insulin?
hormone produced in the pancreas that normally maintains balanced blood glucose level
what is IDDM?
- insulin dependent DM
- 10% of pop
- type 1; juvenile
- absolute deficiency in insulin
what is NIDDM?
- non insulin dependent DM
- 90% of pop (80% overweight)
- type 2; adult
- resistance to insulin action
DM is the leading cause for what two pathologies?
blindness and renal failure
DM can cause what other pathologies?
- heart disease
- kidney disease
what type of neuropathies can a DM patient develop?
what are the cardinal signs of type 1 DM?
- excessive urination
- excessive thirst
- excessive hunger
- weight loss
what are the cardinal signs for type 2 DM?
- everything the same as type 1 but also with
- blurred vision
- cuts and bruises that heal slowly
- tingling, numbness in and and feet
- or NO s/s
what are some of the long term effects of DM?
- vascular problems, retinopathy, kidney disease, peripheral neuropathy
- impaired resistance to infection
what does the medical management of DM include?
- insulin administration
- dietary management
- planned exercises
what are some of the safety concerns for DM patients?
- higher incidence of injuries
- heal slower
- poor vision
- ulcers due to neuopathy
what is insulin shock or too much insulin?
what would a patient that was hypoglycemic present like?
- c/o feeling "faint"
- clammy skin
what would you do for a patient who was hypoglcemic?
provide carb snack like fruit juice, honey, hard candy
what also might cause hypoglycemia?
- overdoes of insulin
- late or skipped meal
- over exercise
what is hyperglycemia?
too little insulin; diabetic comea
what might also cause hyperglycemia?
skipped or delayed insulin injection or too much food
how would a hyperglycemic patient present?
dehydrated, intense thirst, abdominal pain, nausea and vomiting, lethargy, deep and slow breathing, fruity breath, red and dry skin
what are some of the precautions for working with a diabetic patient?
- obeserve for s/s of problems
- be aware of food intake and insulin adminstration prior to treatment
- at least one hour after meal
- replace fluid loss adequately
- take glucose q 30min
how would instruct a DM patient on foot self care?
- daily inspection
- proper footwear
- minimize trauma (no barefoot, flip flops or hot cement)
- maintain strength (pen pennies)
what are some other things you would want to educate your DM patient on?
- burn precautions with local heat
- any heat accelerates the rate of insulin absorption; no heat before 15 min after insulin