PROSTHETIC CPM EXAM WITH COMPLETE QUESTIONS AND ANSWERS | GUARANTEED TO PASS| 100% ACCURATE ANSWERS

PROSTHETIC CPM EXAM WITH COMPLETE QUESTIONS AND ANSWERS | GUARANTEED TO PASS| 100% ACCURATE ANSWERS Anterior suspension strap (inverted Y strap) - RIGHT ANSWER -Location through the delto-pectoral groove, Y forks 1" inferior to the clavicle Base plate position (TH) - RIGHT ANSWER -25mm proximal to end of limb Posterior lateral quadrant of humerus Move proximal lateral: fix force problem Move distal/medial: fix excursion problem Building a recommendation: - RIGHT ANSWER -Socket design Ultralight Acrylic Suspension type Interface (liners, socks, etc) Alignable components Knee Foot Clues: Anterior distal pressure - RIGHT ANSWER -Problem: too much pressure Solution: pretibial pads, extend socket Clues: Anterior proximal redness - RIGHT ANSWER -Problem: excessive pressure anterior/proximal Solution: socket too extended (dynamic) flex socket Clues: bilstering/discoloration of distal limb (socket fit is correct) - RIGHT ANSWER -Problem: milking on the limb due to donning the liner incorrectly Solution: don liner without air at distal end Clues: Delivered wearing 3 ply socks, now back wearing 10 ply socks and has redness/pain - RIGHT ANSWER -Problem: too many socks Solution: remove socks, educate sock ply management Clues: Knee disarticulation using excessive amount of socks - RIGHT ANSWER -Problem: Volume too large? Solution: pad socket Clues: Lateral distal pressure - RIGHT ANSWER -Problem: Foot too inset Solution: outset foot Clues: patient no longer fitting in socket today but fit yesterday - RIGHT ANSWER -Problem: swelling (ate salty meal, not wearing shrinker at night) Solution: educate patient on limb volume changes Clues: redness at distal patella, loose fit - RIGHT ANSWER -Problem: socket fitting too large Solution: add socks, educate sock ply management Clues: Symes pain on medial/lateral malleolus - RIGHT ANSWER -Problem: too much pressure? Not in socket all the way? Solution: Make sure malleoli are reaching the appropriate reliefs, relieve area if necessary Clues: Symes pediatric redness on malleoli after growth spurt - RIGHT ANSWER -Problem: increased pressure due to growth Solution: onion layer socket to allow room for relieving Clues: TF pain and redness on lateral distal femur - RIGHT ANSWER -Problem: lack of ML stability in the socket Solution: ensure ischial containment, pad just proximal to distal lateral femur, adduct socket slightly Clues: Transtibial pain/redness on distal end, distal patella, and fib head - RIGHT ANSWER -Problem: bottoming out Solution: add sock(s) Clues: transtibial with fibula > tibia - RIGHT ANSWER -Problem: danger of putting distal pressure on fibula Solution: Provide relief for the fibula inside the socket Clues: Upper extremity terminal device opening with elbow flexion - RIGHT ANSWER -Problem: EFA too proximal Solution: move EFA distal Clues: Upper extremity terminal device will not open all the way - RIGHT ANSWER -Problem: housing is impacting, crosspoint incorrect location, CAS too loose Solution: check housing, move crosspoint distal to C7 and slightly to sound side, tighten CAS Clues: Verrucous hyperplasia on distal end - RIGHT ANSWER -Problem: lack of total contact Solution: add distal end pad/remake socket to provide total contact Control attachment strap (CAS) location - RIGHT ANSWER -distal 1/3 of scapula Crosspoint location - RIGHT ANSWER -Inferior to C7 toward the sound side increased comfort alternatives at cost of excursion: sewn, northwestern ring, dual ring, expanded crosspoint, baha Dynamic Response feet - RIGHT ANSWER -Pros: use with increased activity level, energy storing, reduces impact to joints and the residual limb, decreased walking effort/increased push off Cons: increased cost/weight E400 Elbow - RIGHT ANSWER -Requires 1.5-2" excursion to cycle (2-3 lb of force) Requires 2.5" to lock/unlock (7-9 lb of force) Motions: GH flexion, scapular protraction To lock/unlock: depression, extension, and abduction Elbow flexion attachment position - RIGHT ANSWER -25 mm anterior, 30 mm distal to joint center Move proximal: less excursion required but more force Move distal: less force required, but more excursion Elevated vacuum (TF) - RIGHT ANSWER -mechanical or electronic Pros: Improved proprioception, Can be used with subischial trimlines Cons: requires cognitive ability, pump adds weight Elevated vacuum (TT) - RIGHT ANSWER -mechanical or electric pump Pros: Good for volume management, increased control/proprioception, wound care advantages Cons: requires sleeve, cognitive ability, pump adds weight, precise fit needed Excursion amplifier - RIGHT ANSWER -doubles the amount of excursion but requires double the force External power feet - RIGHT ANSWER -K1-3, all cadence/terrain Pros: propulsion, dorsi/plantarflexion Cons: batteries/weight/cost/processing speed Figure 8 Harness - RIGHT ANSWER -Control and suspension Figure 9 Harness - RIGHT ANSWER -Control only Flexible keel - RIGHT ANSWER -Pros: provides easy rollover, smooth transition from heel strike to toe off, allows natural sagittal plane motion, reduces socket foreces on residual limb, improves walking safety, reliable Cons: limited push off, increased cost Frontal TF dynamic alignment goals - RIGHT ANSWER -Adequate suspension Width of base of support Control of pelvis during prosthetic stance Quality and pattern of prosthetic swing Hemipelvectomy Socket Principles - RIGHT ANSWER -Weightbearing: IT/soft tissue Suspension: Iliac crests Hip joint + Pelvic band (TF) - RIGHT ANSWER -Sock interface Pros: Maximal ML control, Good if weak abductors or short residual limb, some rotational control Cons: heavy, bulky, pistoning, hard to don, uncomfortable when sitting Pelvic band b/w iliac crests and trochanters Joint 12mm anterior and 25mm proximal to GT Info for Px Eval - RIGHT ANSWER -Name, Age, DOB, Sex Ht, Wt Meds, comorbidities Amp site/cause/date ADLs/vocational/avocational Goals! Home status/environment Work status/environment PT/OT, assistive devices used Current/previous px treatment MMT, ROM Sensation Condition of residual limb Condition of contralateral/upper extremities K-level/AMP Ischial containment trimlines - RIGHT ANSWER -Anterior 50mm (2") proximal to IT Posterior 25mm (1") proximal to IT Medial at ischial level in line of progression Lateral 90 mm (3") proximal to IT Joint + corset (TT) - RIGHT ANSWER -Pros: provides max knee stability, very secure, can help with recurvatum. thigh weightbearing & unloading of limb, heavy duty, don sitting Cons: heavy, bulky, ugly, pistoning K0 - RIGHT ANSWER -The patient does not have the ability or potential to ambulate or transfer safely K1 - RIGHT ANSWER -Prosthesis for transfers or ambulation at fixed cadence; household ambulator K1 feet - RIGHT ANSWER -SACH, Single axis, safe K1-K2 knees - control - RIGHT ANSWER -Fiction/mechanical - single speed ambulators May have manual lock feature Weight activated stance control K2 - RIGHT ANSWER -Ability to traverse low level environmental barriers; limited community ambulator, fixed cadence K2 feet - RIGHT ANSWER -Multiaxial, flexible keel K3 - RIGHT ANSWER -Ambulation at variable cadence; prosthetic utilization beyond simple locomotion; "unlimited" community ambulator, traverse most environmental barriers K3-4 - RIGHT ANSWER -Dynamic response (also often multiaxial) With vertical shock Shock & torque absorbers K3-4 knees - control - RIGHT ANSWER -Fluid (cadence responsiveness) hydraulic or pneumatic -Pros: variable cadence, swing and stance control, more natural gait -Cons: increased weight/maintenance/cost Microprocessor (fluid controlled by "computer chip") K4 - RIGHT ANSWER -Exceeds basic ambulation skills, exhibiting high impact, stress, or energy levels; child, active adult, or athlete. KD Suspension - RIGHT ANSWER -Anatomical with foam liner - Pros: rotational control, increased suspension in swing phase; Cons: suspension localized to one area, not able to use with fluctuating edema Cushion liner Window/door Boa Lacer Seal-in suction Knee disarticulation socket principles - RIGHT ANSWER -Subischial or 3/4 sockets are appropriate Can use anatomical suspension over the condyles Lateral suspension strap - RIGHT ANSWER -Crosses at the level of C7 Attaches over the apex of the shoulder slightly anterior to the acromion Liner + Lanyard (TF) - RIGHT ANSWER -Pros: Seated donning, Great for low mobility/balance, positive lock Cons: pistoning/milking of tissue, single point connection, must have good hand strength Liner + Pin (TF) - RIGHT ANSWER -Pros: Seated donning, positive lock Cons: difficult due to pin angle, soft tissue movement, pistoning/milking of tissue Liner w/ Lock or Lanyard (TT) - RIGHT ANSWER -Pros: positive lock, lower profile, liner protects against shear, increased ROM Cons: can get pistoning/milking, must have full function of upper extremities for liner use, need good subcutaneous tissue, Manual lock knee feature - RIGHT ANSWER -Maximum stance phase stability - K1-K2 prosthesis made slightly shorter use with a single-axis foot is desirable Pros: doesn't require strength, can be used with blind or bilateral patients, extremely stable bc eliminates knee flexion Cons: forces gait deviation Max sock ply before new socket is indicated - RIGHT ANSWER -15-20 ply Microprocessor knees - RIGHT ANSWER -Pros: improve environmental obstacle negotiation, increased walking speed on uneven terrain, reduced falls, increased confidence Cons: heavy Multiaxial feet - RIGHT ANSWER -Pros: Accommodates uneven terrain, decreases stress on skin and prosthesis Con: Increased weight/maintenance, cost Normal anatomical pronosupination - RIGHT ANSWER -90 supination 80 pronation (preserved if 60% of the limb remains) Polycentric - RIGHT ANSWER -K1-K4; 4-bar linkage, moving center of rotation centrode proximal and posterior to weight line Pros: shorten in swing phase, cosmetic in sitting, stability inherent in alignment, stable during stance Cons: Low stability at toe-off, contraindicated for bilateral, increased weight/maintenance/cost Quad trimlines - RIGHT ANSWER -Anterior: 2.5" proximal to IT Medial: at ischial level Lateral: 2.5" proximal to IT Posterior: at ischial level SACH feet - RIGHT ANSWER -Pros: provides stability in early stance Cons: DF stop increases knee hyperextesion Sagittal TF dynamic alignment goals - RIGHT ANSWER -Knee stability throughout stance Smooth loading response Symmetry of step length and duration Quality of knee flexion during late stance and swing SC-SP (TT) - RIGHT ANSWER -Supracondylar with suprapatellar bar (quad bar), easy donning Pros: knee stability (AP and ML), simple, short limbs, good for pts with upper limb involvement, low maintenance, don't need good hygiene, good for less active, easy donning Cons: higher trimlines, bulkier, less cosmetic, restrict knee ROM Scarpa's triangle - RIGHT ANSWER -Inguinal ligament, sartorius, adductor longus Seal-in liner (TF) - RIGHT ANSWER -Pros: Improved proprioception, perceived as lighter, eliminates pistoning, shear forces moderated by liner Cons: must have good hygiene, must have good hand strength, must stand to don, need precise fit Seal-in suction (TT) - RIGHT ANSWER -Pros: one way valve, solid connection, no pistoning, active patients, very secure Cons: little tolerance for volume fluctuation, must have good hygiene Shoulder saddle - RIGHT ANSWER -For heavy duty patients Silesian belt/TES belt - RIGHT ANSWER -Pros:Auxiliary, controls rotation, allows for volume changes Cons: not good for independent suspension, allows pistoning Attached 6mm posterior and 6mm proximal to GT Pulls into adduction Single axis feet - RIGHT ANSWER -Pros: inexpensive, durable Cons: rigid forefoot, not energy efficient, not suitable for uneven surfaces Single axis knee feature - RIGHT ANSWER -Fixed rotation point; stability via alignemnt or muscular control; constant friction - K1-K2 Pros: longer residual limb with good muscle control, children, inexpensive, durable Cons: must have strong hip extensors and good balance, decreased stability Single axis outside hinges - RIGHT ANSWER -PFFD, KD Free swinging Pros: avoid knee length discrepancy, durable Cons: no inherent friction control, no inherent stability, ugly Skin fit suction (TF) - RIGHT ANSWER -Pull sock + expulsion valve Pros: Improved proprioception, Perceived as lighter, Eliminates pistoning Cons: Can be hard on skin, can't have volume fluctuation, must stand to don, need precise fit Sleeve (TT) - RIGHT ANSWER -Pros: minimizes pistoning, can be cosmetic by masking trimlines, can be used as auxiliary suspension, can be used for lots of patients Cons: hot, doesn't last very long, can reduce ROM, large thighs may cause it to roll down Subischial triangle - RIGHT ANSWER -Inferior ramus, gracilis, semitendinosis Supracondylar (TT) - RIGHT ANSWER -pelite liner with wedge, can have removable brim (ML-PML >=12) Pros: knee stability (ML), simple, short limbs, good for pts with upper limb involvement, low maintenance, don't need good hygiene, good for less active, easy donning Cons: higher trimlines, bulkier (thicker), restrict knee ROM Supracondylar cuff/strap (TT) - RIGHT ANSWER -Pros: Simple, suprapatellar suspension, low maintenance, don't need large PML-ML difference, adjustable Cons: Higher trimlines, ugly, bulky, pistoning, may impair circulation TD doesn't fully open at waist/mouth (TH) - RIGHT ANSWER -Excursion problem Solution: tighten CAS, check housing clearance, move EFA distal, move baseplate posterior/distal/medial, add Northwestern ring/Baha/etc; add Z strap TD doesn't open all the way (TR) - RIGHT ANSWER -Excursion problem Solutions: check position of cross point, tighten or lower CAS TD opens before/during elbow flexion (TH) - RIGHT ANSWER -Force problem Solution: move EFA distal, more bands, baseplate anterior/prox/lateral, add forearm lift assist, second base plate, lighter TD, shorten forearm section, check housing clearance, teflon/wax TD too difficult to open (TR) - RIGHT ANSWER -Force problem Solutions: remove rubber band, check for sharp angles on cabling, add teflon/wax to housing TF Bench Alignment - RIGHT ANSWER -5* socket flexion (+contracture) 6-7* socket adduction (or match sound) Socket medial wall parallel to line of progression Knee: 5-25 mm posterior to weightline, external rotation 3-5* Foot: 12-37mm outset from IT, 5-7* external rotation TF Ischial Containment Socket Principles - RIGHT ANSWER -Femur held in adduction Very intimate fit Triangular shape ML compression Indicated for: shorter limbs, requires less voluntary control Potential for ischial weightbearing, high proximal trimline Gluteal and hydrostatic weightbearing Triangular shape TF MAS (ramal containment) Socket Principles - RIGHT ANSWER -Hydrostaic weightbearing Lower trimlines Ramal buttress for ML control TF max LLD - RIGHT ANSWER -1/4" TF Quad Socket Principles - RIGHT ANSWER -4 well-defined walls Rectangular shape Ischial/gluteal weightbearing AP control - Lack of ML support Contours for flexors/extensors Indicated for longer limbs, good voluntary control, previous user TF Subischial Socket Principles - RIGHT ANSWER -Much lower trimlines - KD Use with anatomical suspension or vacuum Long limbs, requires good control and normal ROM of hip TH Cable Clearances - RIGHT ANSWER -Cable 3mm between hanger and proximal housing (extend and pronate) Housing 3mm at proximal and distal ends of cabling, 6mm between proximal and distal housings at elbow (flex, supinate, open TD) TH Cable System Validation Criteria - RIGHT ANSWER ->50% efficiency (force at TD/force at hanger) TD stays closed with elbow flexion <45* GH flexion to activate elbow Shoulder ROM should be 90* abduction, 90* flexion, 30* extension Forearm resists 3lb of internal/external rotation ** requires 4.5-5" of excursion total TR Cable System Validation Criteria - RIGHT ANSWER ->70% efficiency (force at TD/force at hanger) Elbow flexion w/in 10* of anatomical Retain >50% available pronosupination Lift 50 lb or 1/3 of body weight (figure 8) 50 lb axial pull should not displace >12-25mm Trouble shooting tools - RIGHT ANSWER -Lipstick, corset stay, clay/playdough TT acceptable amount of pistoning - RIGHT ANSWER -1cm TT appropriate amount of varus thrust - RIGHT ANSWER -1cm TT Bench Alignment - RIGHT ANSWER -5* socket flexion (+contracture) 5* socket adduction (or match sound) Foot: 37mm posterior to midline (SACH) or 1/3 of foot (DR) Foot: 12 mm inset to midlineder TT Hydrostaic - RIGHT ANSWER -Fluid density loading and tissue elongation Casted under pressure TT Interfaces - RIGHT ANSWER -Socks: also for volume management Foam/pelite liner: custom, easily adjustable, durable Gel liners: cushion/flow, hot, prevents shear Flexible inner socket: reduce edge pressure, reliefs in outer TT loading response knee flexion - RIGHT ANSWER -20* TT PTB SCSP Socket Design - RIGHT ANSWER -Same as PTB with quad bar Provides knee stability Requires PML < ML by at least 12 mm TT PTB Socket Design - RIGHT ANSWER -Indicated for short or bony limbs Rotational control Depressions: MPT bar, medial flare, medial shaft, pretibial area, politeal area, lateral fibula shaft, interosseus space Buildups: tibial crest, lateral flare, fib head, distal fibula, distal anterior tibia Pros: prevents rotation, strategic loading Cons: Scar tissue in loading areas, can be too much for MPT for some patients TT socket pressures: Prox lateral, distal medial - RIGHT ANSWER -Too much adduction Foot too outset TT socket pressures: prox medial, distal lateral - RIGHT ANSWER -Too much abduction Foot too inset TT socket pressures: proximal anterior, distal posterior - RIGHT ANSWER -Anything that results in strong knee extension moment Foot too anterior Foot too plantarflexed TT socket pressures: proximal posterior, distal anterior - RIGHT ANSWER -Anything that results in strong knee flexion moment Foot too posterior Foot too dorsiflexed TT too few socks - RIGHT ANSWER -Redness: Distal fib head, distal patella, distal end of limb TT too many socks - RIGHT ANSWER -Redness: tibial tubercle, prox aspect of fib head, verrucose hyperplasia TT TSB Socket Design - RIGHT ANSWER -Fleshy limbs Lack of rotational control 3-5% global reduction tapering to zero at distal ***Must be used with liner with high flow (TPE) Pros: distributes weightbearing Cons: lack of rotational control, does not relieve for extremely bony patients or neuromas Waist belt (TT) - RIGHT ANSWER -Pros: secure, historic, knee extension assist Cons: bulky, ugly, pistoning Weight activated stance control knee feature - RIGHT ANSWER -"safety knee" good for new amputees Pros: knee is locked when weight is through it - good stability in stance phase, good if weak hip extensors, poor balance, and short TF Cons: not for active or stable patients, delayed swing phase, must unload fully to sit