Prosthetics Assessment Quiz

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Questions and Answers

What aspect should be evaluated to ensure the prosthesis is prescribed correctly?

The presence of piston action when raising the prosthesis.

The ability of the patient to don the prosthesis easily.

Alignment of the prosthesis in relation to knee stability. (correct)

The patient's comfort level while walking.

Which is an important factor in the alignment of the prosthesis?

The knee cuff should be positioned above the knee joint.

There should be no pressure at the lateral or medial brim of the socket. (correct)

The prosthesis should be adjustable to any height.

The shoe should fit snugly within the socket.

What ensures that the uprights of the thigh corset fit appropriately?

They must conform to the flares above the epicondyles. (correct)

They should be adjustable without affecting stability.

They should align with the midline of the thigh.

They should not contact the epicondyles at all.

What indicates that the patient can sit comfortably with the prosthesis?

There is minimal bunching of soft tissues in the popliteal region. Signup and view all the answers

What performance aspect is checked when the amputee is walking?

Gait deviations that require attention. Signup and view all the answers

What should be minimal when the patient raises the prosthesis?

Piston action between the stump and socket. Signup and view all the answers

What is not a requirement for satisfactory performance in walking?

The patient must be able to kneel. Signup and view all the answers

Which feature is essential for the thigh corset’s intended function?

The length and construction must support weight-bearing or stabilization. Signup and view all the answers

What indicates that the ischial tuberosity is positioned too far posterior on the ischial seat?

There is a burning sensation near the hamstring tendons. Signup and view all the answers

How should the examiner confirm the position of the ischial tuberosity on the ischial seat?

By palpating the ischial tuberosity while the amputee bends forward. Signup and view all the answers

What can be a consequence of having an insufficient bulge in Scarpa's triangle area?

Inadequate counterpressure leading to discomfort in the adductor region. Signup and view all the answers

What should be checked to ensure the prosthesis is the correct length?

The heights of the iliac crests. Signup and view all the answers

What could indicate that the ischial tuberosity is too far inside the socket?

A sensation of burning in the crotch area. Signup and view all the answers

Which condition can crowd the adductors and cause discomfort?

A downward slant of the ischial seat. Signup and view all the answers

What approach should be taken when examining older or unstable patients during the process?

Face the amputee on the side of the prosthesis. Signup and view all the answers

If the ischial tuberosity is slightly above the ischial seat, what type of patient might this most likely occur in?

A patient with a muscular build. Signup and view all the answers

What might happen if the prosthesis is too short?

The lumbar scoliosis will have convexity toward the prosthesis. Signup and view all the answers

What is an acceptable deviation of the brim of the posterior wall from the horizontal?

5º Signup and view all the answers

What indicates a knee is stable during weight-bearing?

It gives slightly but returns immediately to full extension. Signup and view all the answers

What should the positioning of the knee bolt be for an amputee with a medium to long stump?

Approaching the trochanter-ankle reference line closely, but not anterior. Signup and view all the answers

What is a common source of discomfort for an amputee in the area of the perineum?

Pressure of the inferior ramus against the medial brim. Signup and view all the answers

What is a sign that the amputee is experiencing pressure in the perineal area?

They report discomfort when crossing the prosthesis in front of the sound leg. Signup and view all the answers

Why is it important that the weight distribution is even between the ischium and gluteal muscles?

To prevent skin breakdown and discomfort. Signup and view all the answers

What might result if the prosthesis is perceived as too long by an amputee?

Difficulty adapting to the new prosthesis. Signup and view all the answers

What is the effect of insufficient radius on the medial brim of the socket?

It increases pressure in the perineum. Signup and view all the answers

What should occur when the valve of a total-contact socket is removed regarding stump tissue?

The stump tissue should protrude slightly into the valve hole. Signup and view all the answers

Where should the lateral attachment of the Silesian bandage be positioned?

1/4 inch above and 1/4 inch posterior to the greater trochanter. Signup and view all the answers

What indicates sufficient compression of the stump when the valve is removed?

Protrusion corresponds to the thenar eminence of the thumb. Signup and view all the answers

What could result from an incorrect anterior attachment placement of the Silesian bandage?

Improper socket fit affecting limb rotation. Signup and view all the answers

How should the pelvic band fit relative to the contours of the body?

Accurately to minimize piston action. Signup and view all the answers

What effect does an anterior pelvic tilt have on pressure in the perineum?

It can increase pressure in the perineum. Signup and view all the answers

What happens if the medial wall of the socket is too high?

It can lead to discomfort and increased pressure. Signup and view all the answers

What does loud noise from a socket indicate during usage?

Incorrect socket fit Signup and view all the answers

What is an important observation to make while assessing a patient walking with a prosthesis?

Gait deviations may indicate compensatory adaptations Signup and view all the answers

What should be checked to ensure suction is maintained during walking?

Absence of piston action Signup and view all the answers

What could cause failure to maintain suction in a prosthesis?

Accumulation of debris in the valve Signup and view all the answers

Why is continued contact between the stump and socket important during walking?

It reduces the risk of edema due to negative pressure Signup and view all the answers

What should be done if the patient experiences piston action in the prosthesis?

Investigate the fit and maintain contact Signup and view all the answers

During an assessment, what action should be taken when observing the patient navigating inclines or stairs?

Evaluate the patient's balance and technique Signup and view all the answers

What must be checked immediately after the prosthesis is removed?

For areas of localized edema on the stump Signup and view all the answers

What is the recommended anterior extension of the metal band for short stumps?

1 inch medial to the anterior superior spine Signup and view all the answers

What happens if the pelvic belt exerts pressure on the anterior superior iliac spine?

It may cause irritation to the patient's back Signup and view all the answers

Where should the pelvic joint be located in relation to the greater trochanter?

Slightly ahead and slightly above the greater trochanter Signup and view all the answers

Which aspect is preferred for the location of the valve in a prosthesis?

On the anteromedial aspect of the prosthesis Signup and view all the answers

What could cause the socket to change position while the patient is seated?

Improper fitting of the stump sock Signup and view all the answers

What vertical inclination is recommended for the valve in order to minimize friction?

It should have a sufficient vertical inclination limited only by thigh length Signup and view all the answers

What should be checked to ensure the socket remains securely on the stump while the patient is seated?

If there is gapping in the rectus femoris or gluteal channels Signup and view all the answers

Which of the following should not occur if the socket is properly fitted?

Secure fit of the socket while seated Signup and view all the answers

Study Notes

Checkout Procedures for Prostheses

Checkout procedures ensure prostheses meet standards and identify areas needing adjustment.
Procedures apply to all types of prostheses (below-elbow, above-elbow, above-knee, below-knee, etc.).
Checkout focuses on comfort, stability, alignment, appearance, and workmanship.
Specific items for below-knee prostheses are outlined on pages 284-286.
Practical judgment and valid reasons for deviations from standards are crucial in checkout procedures.
Checkout forms, tools (yardstick, boards, bars, chair, stairs, ramp), and appropriate support are necessary.

Below-Knee Prosthesis Checkout Items

Prescription Adherence: Ensure the prosthesis conforms to the prescribed design and previous recommendations have been implemented (re-check procedures included).
Donning Ease: The amputee should be able to don the prosthesis easily. Socket size (circumference, mediolateral, and anteroposterior) is crucial for easy donning. Sharp edges can also impede donning (supracondylar suspension).
Standing Comfort: Amputee comfort is evaluated with heels a maximum of 6 inches apart (weight distribution is necessary).
Anteroposterior Alignment: Assess knee stability/lack of forced backward movement. The amputee's knee should feel stable and not forced.
Mediolateral Alignment: Verify the shoe is flat on the floor, and no discomfort from pressure at the sides (medial or lateral brim) of the socket.
Correct Length: Ensure prosthetic leg matches the length of the sound leg (pelvis level using physical landmarks such as posterior superior iliac spines, iliac crests, and anterior superior iliac spines).
Pistons Action: Minimal movement between the stump and socket when raising the prosthesis (various potential causes detailed).
Socket Wall Height: Evaluate the height of the anterior, medial, and lateral walls; consider the placement on epicondyles and areas above (consider patellar-bearing variants).
Thigh Corset Fit: Ensure proper fit, enabling adjustment for weight-bearing or stabilization. Its construction and length are part of the evaluation.
Comfort While Sitting Flexed: Evaluate for bunching of tissues in the popliteal region, with knees flexed to 90-degrees, in a seated position.

Prosthesis Functionality and Appearance

Walking Evaluation: Assess level walking performance; note gait deviations to be addressed later. Evaluate patient performance on inclines and stairs.
Piston Action Considerations: Evaluate for minimal piston action between the socket and stump.
Kneeling Ability: The amputee should be able to kneel comfortably with minimal pressure, adjusting for possible discomfort while sitting.
Quiet Function: Analyze for any unusual noises emanating from the prosthesis (potential sources of noise).
Appearance: Match prosthetic size, contours, and color with the sound limb. Assess the patient's perception of prosthetic satisfaction.
Stump Condition: Note stump's condition in aspects such as abrasion, discoloration, and perspiration immediately following prosthesis removal (differentiating recently acquired conditions from pre-existing ones).

Proper Weight-Bearing and General Workmanship

Weight Distribution: Evaluate if weight is distributed evenly across appropriate stump areas.
Wedge Dimensions: The wedge's size needs to be correct.
Posterior Socket Wall Height: Height of the posterior wall is needed to minimize popliteal rolls/stump stabilization.
Straps and Their Adjustments: Check for adjustable straps’ secure attachment and adequate adjustment.
Overall Workmanship: The overall quality of materials and construction, including rivets, fastenings, leather, lamination, and joint covers.

Above-Knee Prosthesis Checkout (Summary)

Similar general pattern to Below-knee protocol (standing, sitting, walking assessments).
Crucial for correct socket placement on the stump for evaluation.
Special attention given to training and deficiencies.
Specific items for above-knee prostheses are listed on pages 296-299/Additional explanations provided.
Checkout procedures are provided for the above-knee prosthesis, with considerations of the patient's ability to use the prosthesis effectively at final checkout.

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Description

Test your knowledge on the critical factors in prescribing and aligning prosthetic devices. This quiz covers essential aspects of ensuring proper fit, comfort, and functionality for amputees. Evaluate your understanding of the features necessary for successful prosthetic performance.