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STEPHANIE SHANE OTR/L

UE level amputation

• Forequarter:loss of clavicle, scapula, and entire UE

• Shoulder disarticulation: loss of entire UE

• Above elbow (long or short): amputation above the elbow

• Elbow disarticulation: amputation or the UE distal to the elbow joint

• Below-elbow (BE) (long or short): amputation below the elbow at any level of the forearm

• Wrist disarticulation: amputation distal to the wrist joint, loss of entire hand

• Finger amputation: amputation of the digit (s) at any level

LE level of amputation:

• Hemipelvectomy: amputation of half of pelvis and entire LE

• Hip disarticulation: amputation at the hip joint, loss of entire LE

• Above-knee amputation (transfermoral): amputation above knee at any level on the thigh

• Knee disarticulation: amputation at knee joint

• Below-knee amputation (transtibial): amputation below knee at any level on the thigh

• Knee disarticulation: amputation at knee joint

• Below-knee amputation (transtibial): amputation below knee at any level on the calf (most common)

• Complete tarsal: amputation of metatarsals and phalanges

• Partial tarsal: amputation of metatarsals and phalanges

• Complete phalanges: amputation of the toe (s)

Terminal Devices (TDs)

• Function to grasp and maintain hold on an object. The two main types are the hook and the hand.

o Voluntary opening (VO): hook remains closed until tension is placed on cable and then it opens

o Voluntary closed (VC): hook remains opened until tension is placed on cable and then it closes

o Determining the most appropriate TD is based upon the person’s interests, roles, and preferences.

▪ TDs can be interchangeably used with a prosthesis if the shaft size is the same.

Complications:

• neuromas-nerve endings adhered to scar tissue, skin breakdown, phantom limb syndrome-sensation of the presence of the amputated limb, and infection.

• Knee flexion contractures in transtibial amputation

• Psychological impairments due to shock or grief.

Preprosthetic Treatment

1. Change of dominance activities, if needed.

2. ROM of uninvolved joints

3. Prepare limb for prosthesis

4. Desensitization

5. wrapping to shape and shrink residual limb

o wrap distal to proximal

o tension should decrease with proximal wrapping

6. ADL training including education in skin care

7. Supportive counseling to facilitate adjustment

8. Individualize treatment to enhance physical and psychological adjustment.

Prosthetic Treatment

1. Functional training with prosthesis

a. Practice engagement in activities of interest and occupational role activities.

2. Donning and doffing the prosthesis

3. Increase prosthetic wearing tolerance

4. Individualize treatment to enhance physical and psychological adjustment

Treatment for LE Amputations

1. Wrapping to shape residual limb and decrease swelling

2. Desensitization

3. Strengthening (UE) with the focus on triceps

4. Transfer training, stand pivot

5. ADL traning, LE dressing is the most difficult.

6. Standing tolerance

7. W/C mobility

• Phantom limb pain: pain in a limb following amputation of that limb following amputation of that limb; differentiated from far more common phantom limb sensation.

Diabetes: complications can be amputations

• S/P amputation of the LE: may require training regarding use of pillows to prevent edema in the LE, may also need training on how to provide passive stretching to residula limb while inbed to prevent shortening or contracture, which would make prostethic training difficult and painful.

• What is neuroma: A _____ is an unorganized mass of nerve fibers resulting from a laceration (either surgical or accidental) or amputation in which the nerve regrows in unorganized bundles. Results in sharp, radiating pain.

• What are the methods used to treat hypersensitivity, such as burns, amputations, PNS injuries, etc?

Desensitization, compensation (such as testing hot water with other hand)

37. A 60-year-old auto-mechanic with diabetes and impaired sensation in the residual lower limb has been referred to OT following an above-knee amputation. The FIRST item the OT practitioner should address is:

a. Skin inspection.

b. Grooming techniques (shaving, trimming toenails, etc.).

c. Retirement planning.

d. Returning to work.

Answer: A

Question 50

Test ID: 47788 Question ID: aota-qa_q796

An OTR® is working with a client with a unilateral transradial amputation. The client is switching to a salesperson position from a computer operator position. The client does not wear a prosthesis and is independent in all one-handed skills. The client is concerned that the appearance of a residual limb may put the client at a disadvantage during sales calls and would like to obtain a prosthesis. What is the BEST prosthesis for the client?

A.

An active realistic myoelectric prosthesis

B.

An active realistic prosthesis

[pic]C.

An passive hook prosthesis

D.

A passive realistic cosmetic prosthesis

Incorrect. You answered C. 

The right answer is D

The client’s goal for the prosthesis is cosmetic. The client is a high-functioning one-handed person and does not require an active prosthesis. The additional time and expense needed to develop prosthetic skills is not warranted given the client’s current level of functioning.

Question 64

Test ID: 47788 Question ID: aota-qa_q795

A client with a transfemoral amputation who is being fitted for a prosthesis is reporting severe pain when placing weight on the end of the residual limb. The OTR® examines the limb but does not see any reddened or open areas. What is this pain MOST likely the result of?

A.

A neuroma

[pic]B.

Phantom sensation

C.

Phantom limb

D.

A sebaceous cyst

Incorrect. You answered B. 

The right answer is A

A neuroma is a ball of nerve tissue that occurs when axons attempt to grow back in the distal limb. They can be painful when pressed but are not necessarily visible.

Keenan, D. D., & Glover, J. S. (2013). Amputations and prosthetics. In H. M. Pendleton & W. Schultz-Krohn (Eds.), Pedretti’s occupational therapy: Practice skills for physical dysfunction (7th ed., pp. 1149–1183). St. Louis, MO: Elsevier; p. 1154.

Explanations of Incorrect Answers

B: Phantom sensations are pain and tingling that are perceived by the client to occur in the missing limb. They occur spontaneously and do not require an outside force to be activated.

C: Phantom limb is the sensation that the missing limb is still there. It is not painful.

D: A sebaceous cyst is a keratin-filled sac caused by irritation of the skin by the torque forces of the prosthesis. They are raised, movable bumps on the skin and are usually painless.

Keenan, D. D., & Glover, J. S. (2013). Amputations and prosthetics. In H. M. Pendleton & W. Schultz-Krohn (Eds.), Pedretti’s occupational therapy: Practice skills for physical dysfunction (7th ed., pp. 1149–1183). St. Louis, MO: Elsevier; pp. 1153–1154.

Question Classification

NBCOT® Domain:

DOMAIN 2: Formulate conclusions regarding client needs and priorities to develop and monitor an intervention plan throughout the occupational therapy process

Topic:

Musculoskeletal impairments

Question 92

Test ID: 47788 Question ID: aota-qa_q626

Retired NBCOT® Question

An OTR® is ordering a wheelchair for a client with bilateral transfemoral amputations. The client does not have prostheses and has no intention of using prosthetic limbs in the future. Based on this information, which design feature would be MOST BENEFICIAL to include as part of the wheelchair prescription?

A.

Backrest with vertical zipper

B.

Anti-tipping attachments

[pic]C.

5-inch (8-cm) diameter pneumatic front casters

D.

Adjustable cushioned arm rests

Incorrect. You answered C. 

The right answer is B

Antitippers reduce the likelihood of tipping the chair backward during weight shifting, and because the client no longer has support through the lower extremities by resting the foot on the floor, balance when repositioning must be considered.

Keenan, D. D., & Glover, J. S. (2013). Amputations and prosthetics. In H. M. Pendleton & W. Schultz-Krohn (Eds.), Pedretti’s occupational therapy: Practice skills for physical dysfunction (7th ed., pp. 1149–1193). St. Louis, MO: Mosby; p. 1185.

Explanations of Incorrect Answers

A, C, D: None of these design features would be beneficial in improving the support for the client while weight shifting in the wheelchair.

Keenan, D. D., & Glover, J. S. (2013). Amputations and prosthetics. In H. M. Pendleton & W. Schultz-Krohn (Eds.), Pedretti’s occupational therapy: Practice skills for physical dysfunction (7th ed., pp. 1149–1193). St. Louis, MO: Mosby; p. 1185.

A 17 year old with congenital right below elbow amputation had never wanted a prosthesis before. Now the teen wants a prosthesis to look good at prom and for going on date. The ot:

a.Recommends a prosthesis with a cosmetic passive hand

b. Recommends a prosthesis with a voluntary opening hook

c.refuses to recommend a prosthesis for purely cosmetic reasons.

d. recommends a prosthesis with a myoelectrically controlled hand.

Answer D: it is cosmetically appealing and functional for age appropriate bilateral FM activities.

[pic]

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