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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
what is middle old?
the branch of medicine that treats all problems perculiar to old age and the aging, including the problems of senescence and senility
the scientific study of the problems of aging in all their aspects; clinical, biological, historical, and sociological
the gradual changes in the structure of any organism that occur with the passage of time that do not result form disease or other gross accidents and eventually lead to the increased probability of death
older adults or aged individuals who are lacking in general strength and are unusually susceptible to disease or tother other infirmity; those who require help
prejudice or discrimination against people of a particular age and especially older adults
the observed age at death of an indvidual
the highest documented age was ______ and her name was?
- Mme. Jeanne Calment of Aries France
the number of years based on stastical averages that a given person of a secific age or class may reasonably expect to continue living; the average number of years from birth that an individual can expect to live
a diseased condition or state; the incidence or prevelance of disease or of all diseases in a population, the relative incidence of disease
the quality or state of being mortal; death the number of deaths in a given time or place; the proportion of deaths to population
the presence of coexisting or additional diseases with reference to an additional diagnosis with reference to the index condition that is the subject of study.
what theory believes that aging follows a biological timetable, perhaps a continuation of the one that regulates childhood growth and development
what theory believes that environmental assaults to our systems gradually cause things to go wrong.
damage or error theories
aging causes the body to respond differently to what?
- changes in the environment
what are some of the concerns with aging?
- living longer with cardiac disease, DM or other chronic disease
- cognitive changes
on average, a 75 y/o has ____ chronic medical conditions and take ____ Rx.
what are some of the age related changes that can affect the nurtiritinal status of your patient?
- decreased saliva
- poor dentation
- decrements of taste and olfaction
- gastromucosal atrophy
- reduced intestional mobility
what is sarcopenia?
age related loss of lean muscle mass
why is obesity common in the older adult?
- decreased activity, medication, poor diet
- can also be impacted by arthritis, HTN, heart disease, and DM
what type of diet should the older adult consume?
nutrient rich, higher quality diet
how can medications affect the nutritional status of the older adult?
- impact on appetite
- excretion of nutrients
what are some of the cognitive changes the older adult may have to face?
- problem solving declines with age, may be due to educational level and fluid intelligence
- encoding and retrieval problems cause memory difficulties
- short term memory stores seem to have a limited capacity whereas long term memory stores have unlimited capacity
what are the major risk factors for cognitive changes in the older adult?
- family history
how can we slow down the cognitive decline in older adults?
- nutrition and supplemntation
- -15-20% fat diet
- vitamin E, DHA, ginkgo,
- Stress management
how can we maintain cognitive abilites in the older adult?
- exercise:ncreases blood flow and releases endorphins
- brain exercise: neuorplasticity
what can we do to improve the cognitive performance of a older patient?
- orderly environment
- simple, concrete instructions
- appropriate rate
- meaningful tasks
- ample time for practice and repetition
T/F: sudden loss of mental acuity may be due to acute illness, infection, MI, or CVA
what are some of the condtions that can cause reversible dementia?
- drug reactions
- post trauma/surgery
what are some of the things you would see if your patient was experenceing a congnitive decline?
- changes in sensory perception
- loss of memory
- ADL's performed more slowly
- learning of new skills is slower
what are some of the psychosocial aspects of aging?
- depression in many forms
- social isolation
what are some of the age related musculoskeletal changes?
- joint capsules, ligaments, tendons lose elasticity
- joint cartilage loses water, wears down
- joints lose ROM, flexors particulary shorten
- pain may hamper mobility
- osteoporosis risks
what are balance issues due to with the older adult?
- decreased vision, proprioception, ROM and strength
- longer reaction time
- disease related impairments
what are some of the tests you might do to access the patients balance?
what is a major cause for accidental deaths among the elderly?
T/F: not all falls are preventable
what are some of the risk factors for falls among the elderly?
- balance problems, vestibular dysfuntion
- decreased hearing and vision
- proprioceptive loss
- neurological (dementia, CVA)
- foot problems; shoe problems
- anxiety due to previous falls
what is a metabolic disease that results in decreased bone mass causing weakened bone and increased susceptibility to fracture
what are the 2 types of osteoporosis?
- primary: idopathic, post-menopausal, senile
- secondary: underlying disease (CA, alcoholoism) or medication use (long term corticosteroid use; autoimmune)
what are some of the risk factors for osteoporois?
- little white women
- tobacco or alcohol use
what are some of the dietary risk factors for osteoporosis?
- deficient Ca, vitamind D, magnesium
- high fat diets
- high sugar intake
- high intake of Ca deficient beverages (soda, coffee)
- eating disorders
- crash diets
what are some of the comorbidities that would increase the risk of osteoporosis?
- renal disease
waht is bone mineral density testing done for?
what are some of the treatment options for osteoporosis?
meds, hormone replacement, calcitonins, fall prevention and education, exercise and proper nutrition
nonadherance to prescriptions among the elderly is most commonly due to what?
- desire to reduce adverse affects
- cost of meds
what are the most common adverse affects of medications?
- postural hypotension
- movement disorders
- depressed appetite
- nausea and vomiting
- interference with metabolism of nutrients
what is the use of more than one medication to achieve a therapeutic goal, use or administration of more drugs that clinically indicated?
what are some risks for polypharmacy?
- decreased vision
- memory decline
- altered function-arthritic hands
- altered absorption, distribution, clearance of drugs in older body
- chronic illness
- multiple healthcare providers
- number of Rx drugs, doeses per day
- self medication
- adverse drug reactions may mimic typical image of aging-dizziness, confusion, falls, fatigue, incontince
what are some of the outcomes of polypharmacy?
- adverse drug reactions
- drug-drug reactions
- unnecessary cost
how can you be proactive in reducing the chances for polypharmacy?
- ask patient to ID all meds and to bring them in a brown bag to their visit.
- always ask your patient if they have been to the doctor and had a change in Rx regimen
- coordinate care among health care teams
what is the most common adult psychiatric disorder?
what is depression?
morbid sadness, dejection or melancholy
depression is associated with what?
numerous physical condtions, drugs, and somatic symptoms
what are some s/s of clinical depression?
- depressed mood, loss of interest daily for >2 weeks
- persistence of s/s for >2 months following loss
- sleep disturbances, restlessness, fatigue
- feelings of worthlessness, guilt
- decreased concentration and decision making ability
- recurrent thoughts of suicide
what are some of the risk factors for clinical depression?
- previous history
- family history
- medical history
- age (most common in the elderly)
when worried about suicide, what are the most important things to look for?
- "i dont know how much longer i can take this" statements
- abrupt improvement in mood (thats when they decide today is the day)
what is the M0590 from Oasis?
depressive feelings reported or observed in patient and they mark (or you) that apply
what is the geriatric depression scale?
short form with 15 questions that are answered with yes/no. A score above 5 indicated referral for proable depression
chronic pain disorders are often associated with what?
what are some chronic pain disorder?
- persistent neck/back pain
- peripheral neuropathies
- myofascial pain syndrome
- spinal stenosis
what are the 3 D's?
what is progressive failure of many cerebral functions that is characteried by decrease in cognitive functions?
what is the difference btw delirum and dementia?
dementia has an isidious onset that is progressive. delirium is a temporary, abrupt onset.
what is the clinical significance of delirium?
- often accompanies changes in medical status and hopsitilzations
- is reversible
- is associated with severe adverse outcome if not reversed
what are the ways in which the elderly are most commonly abused?
physical, sexual, psychological
what if fragility of multiple body systems as their customary reserves diminish with age and disease; difficulty in maintaining homeostasis. A fatal chronic condition in which all of the body systems have littel reserve and small upsets cause cascading health problems?
when you have a frail patient what are some things you need to consider?
- anorexia/weight loss
- slow gait
- low physical activity
- social factors; low education, low income, lack of family, lack of support
what are some of the effects being frail can have on your patient?
- loss of mobility
- decreased social activity
- tendency to become incontinent
- overall decreased fucntion
- tendency to be hopsitalized, institutionalized
how can we prevent our patients from becoming frail
- maintain food intake
- stay active; walk, resistance exercise
- avoid isolation
- limit pain
- be proactive
what are some of the considerations with rehab for the elderly?
- minimize loss of function
- keep disabilty from becoming a source for social decline
- help elderly maintain I and preferred lifestyle
what are some of the obstacles to rehab with the elderly?
- more difficulty learning (sensory changes, cognitive, etc)
- loss of stamina, endurance required with increaed activity
- overall loss of reserves(frail)
T/F: the elderly respond the exercise the same way the younger population does.
what are the body systems that need to be assessed before rehab begins?
- disease specific