Prosthetics ALREADY PASSED
The primary responsibility of the occupational therapist in the rehabilitation program consists of
- formulation and execution of the preprosthetic program and prosthetic training.
Preprosthetic phase - the treatment plan involves preparing the limb for a prosthesis
prosthetic phase - treatment involves increasing tolerance and function with the prosthesis.
The rehabilitation program involves - an individualized intervention plan that helps the client
with physical and psychological adjustments to function as independently as possible.
Most amputations may result from - 1.trauma; 2.peripheral vascular disease (PVD);3. peripheral
vasospastic disease; 4.chronic infection; 5.chemical, 6.thermal, or 7.electrical injury; or
8.malignant tumor.
The major cause of lower limb amputation is - PVD, often associated with smoking and diabetes.
Approximately 75% of upper limb amputations in adults are caused by - trauma.
The surgeon attempts to preserve as much - length as possible and to provide a residual limb that
has good soft tissue coverage and vascularization.
Preservation of limb length directly affects - the type of prosthesis that the limb can support
During and after surgery the primary goal is to - form a residual limb that maintains maximal
function of the remaining tissue and allows maximal use of the prosthesis.
The open method allows - drainage as the surgical site heals and minimizes the possibility of
infection.
,The closed method - reduces the period of hospitalization but also reduces free drainage and
increases the risk of infection.
When the surgeon reconstructs a residual limb (sometimes referred to as a stump) this is done to
- achieve optimal prosthetic fitting and function.
Several factors and potential problems can affect the outcome of rehabilitation: - 1. Length of the
residual limb, 2. skin integrity, 3.edema, 4.sensation, 5.pain, 6.time for healing, 7.infection, and
8.allergic reaction to the prosthesis.
account for most postsurgical problem - skin
-
o Complications of Preprosthetic phase- - 1.Delay healing (earliest preprosthetic complication)
results in postponed prosthetic fitting, and development of necrotic areas.
Extensive skin grafting- if skin graft adheres to the bone - the area may ulcerate. Daily massage
decreases skin graft adherence to bone.
o Complications of prosthetic phase- - 1.Skin breakdown (ill fitting socket or wrinkles in the
prosthetic sock), 2.ulcers, 3.infected sebaceous cysts (torque forces between socket and residual
limb), and 4. allergic reactions.
o Complications of both phases- - 1.Residual limb edema. Immediately after surgery, the residual
limb is normally edematous as a result of fluid that collects within the soft tissues, especially in
its distal portion.
Compression wrap- - ping, that is, wearing a prosthetic sock or a rigid dressing, helps decrease
the edema.
, Sensation- - Residual limb hyperesthesia, neuroma, and phantom sensations are problems that
interfere with functional use of the limb with or without the prosthesis
Residual limb hyperesthesia - - overly sensitive limb. Desensitization consists of texture
stimulation, tapping, and massage.
o Neuroma- - small ball of nerve tissue that develops when growing axons attempt to reach the
distal end of the residual limb. Most neuromas occur 1 to 2 inches (2.5 to 5 cm) proximal to the
end of the residual limb and are not troublesome.
o phantom limb - . sensation of the limb that is no longer there. The phantom usually occurs
initially immediately after surgery.
o Phantom sensations are different from phantom limb in that they are - detailed sensations of the
limb. Individuals may describe these as cramping, squeezing, relaxed, numb, tingling, painful,
moving, stuck, shooting, burning, cold, hot, or achy. Phantom sensations are described as
constant or intermittent.
·-
Bone - - formation of bone spurs
· Wound Healing factors affecting would healing - -smoking, failure of limb revascularization,
severity of vascular problem, diabetes, renal disease, cardiac disease.
Body-Powered Prostheses factors? - The client's age, medical status, amputation level, skin
coverage, skin condition, cognitive status, and desire for a prosthesis are important factors in
making the decision.
Levels of amputation and functional losses in the upper limb - The higher the level of
amputation, the greater is the functional loss of the limb. TABLE 43.1 page 1157
The primary responsibility of the occupational therapist in the rehabilitation program consists of
- formulation and execution of the preprosthetic program and prosthetic training.
Preprosthetic phase - the treatment plan involves preparing the limb for a prosthesis
prosthetic phase - treatment involves increasing tolerance and function with the prosthesis.
The rehabilitation program involves - an individualized intervention plan that helps the client
with physical and psychological adjustments to function as independently as possible.
Most amputations may result from - 1.trauma; 2.peripheral vascular disease (PVD);3. peripheral
vasospastic disease; 4.chronic infection; 5.chemical, 6.thermal, or 7.electrical injury; or
8.malignant tumor.
The major cause of lower limb amputation is - PVD, often associated with smoking and diabetes.
Approximately 75% of upper limb amputations in adults are caused by - trauma.
The surgeon attempts to preserve as much - length as possible and to provide a residual limb that
has good soft tissue coverage and vascularization.
Preservation of limb length directly affects - the type of prosthesis that the limb can support
During and after surgery the primary goal is to - form a residual limb that maintains maximal
function of the remaining tissue and allows maximal use of the prosthesis.
The open method allows - drainage as the surgical site heals and minimizes the possibility of
infection.
,The closed method - reduces the period of hospitalization but also reduces free drainage and
increases the risk of infection.
When the surgeon reconstructs a residual limb (sometimes referred to as a stump) this is done to
- achieve optimal prosthetic fitting and function.
Several factors and potential problems can affect the outcome of rehabilitation: - 1. Length of the
residual limb, 2. skin integrity, 3.edema, 4.sensation, 5.pain, 6.time for healing, 7.infection, and
8.allergic reaction to the prosthesis.
account for most postsurgical problem - skin
-
o Complications of Preprosthetic phase- - 1.Delay healing (earliest preprosthetic complication)
results in postponed prosthetic fitting, and development of necrotic areas.
Extensive skin grafting- if skin graft adheres to the bone - the area may ulcerate. Daily massage
decreases skin graft adherence to bone.
o Complications of prosthetic phase- - 1.Skin breakdown (ill fitting socket or wrinkles in the
prosthetic sock), 2.ulcers, 3.infected sebaceous cysts (torque forces between socket and residual
limb), and 4. allergic reactions.
o Complications of both phases- - 1.Residual limb edema. Immediately after surgery, the residual
limb is normally edematous as a result of fluid that collects within the soft tissues, especially in
its distal portion.
Compression wrap- - ping, that is, wearing a prosthetic sock or a rigid dressing, helps decrease
the edema.
, Sensation- - Residual limb hyperesthesia, neuroma, and phantom sensations are problems that
interfere with functional use of the limb with or without the prosthesis
Residual limb hyperesthesia - - overly sensitive limb. Desensitization consists of texture
stimulation, tapping, and massage.
o Neuroma- - small ball of nerve tissue that develops when growing axons attempt to reach the
distal end of the residual limb. Most neuromas occur 1 to 2 inches (2.5 to 5 cm) proximal to the
end of the residual limb and are not troublesome.
o phantom limb - . sensation of the limb that is no longer there. The phantom usually occurs
initially immediately after surgery.
o Phantom sensations are different from phantom limb in that they are - detailed sensations of the
limb. Individuals may describe these as cramping, squeezing, relaxed, numb, tingling, painful,
moving, stuck, shooting, burning, cold, hot, or achy. Phantom sensations are described as
constant or intermittent.
·-
Bone - - formation of bone spurs
· Wound Healing factors affecting would healing - -smoking, failure of limb revascularization,
severity of vascular problem, diabetes, renal disease, cardiac disease.
Body-Powered Prostheses factors? - The client's age, medical status, amputation level, skin
coverage, skin condition, cognitive status, and desire for a prosthesis are important factors in
making the decision.
Levels of amputation and functional losses in the upper limb - The higher the level of
amputation, the greater is the functional loss of the limb. TABLE 43.1 page 1157
