PTA 8: Prosthetic Care for Transfemoral Amputation

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61 Questions

Shoulder flexion, abduction, and lateral rotation are components of which UE PNF pattern?

D2 flexion

The use of specific handling techniques to facilitate posture, alignment, and motor control is a component of which neurological rehabilitation approach?

Motor control: a task-oriented approach

Which of the following TUG times indicates that the patient is at the limit for functional independence?

30 seconds

What is the maximum score and the score that indicates an increased risk of falling according to the Berg test?

Maximum score 52 and a score of 26 or below will indicate an increased risk of falling

Which of the following is a term for movement impairment where the patient is unable to control the range of movement and the force of muscular activity?

Dysmetria

A combination of bilateral UE asymmetrical patterns performed as a diagonal activity is called:

Chopping

A PNF technique that involves a slow and resisted concentric contraction of agonists and antagonists around a joint without rest between reversals is called:

Slow reversal

Which of the following may be defined as the act of moving an extremity into a position that the patient must hold against gravity?

Placing

The therapist has positioned the patient and is about to perform which of the following UE PNF patterns?

D1 extension

A 10-year-old girl with cerebral palsy exhibits slow involuntary movements of her UEs and LEs. This motor disturbance is MOST representative of:

Athetosis

During physical therapy, a 16-year-old female's mother's comments upset her and lead to a loss of concentration. The MOST appropriate action is to:

Ask the mother to return to the waiting area

Which of the following is a positive reaction for the Crossed Extension Reflex?

Upon flexion of the extended LE, the opposite LE extends

Which reflex would interfere with this activity if it was NOT integrated?

STNR

When assessing the startle reflex, what is the MOST appropriate stimulus?

A loud, sudden noise

What reflex would you expect to be positive if the child has difficulty with protective reactions in sitting?

ATNR

Which of the following does not need to be considered when ace wrapping a transtibial amputation?

More pressure should be provided distally to enhance shaping

Which of the following is not an advantage for a rigid dressing for a patient who is status post transtibial amputation?

does not limit edema

Which of the following would not be an appropriate activity for a patient who is post-op day 3 from a transtibial amputation?

transfer patient out of bed and ambulate patient

A patient is scheduled to undergo a transtibial amputation of the left LE. Given the patient's past and current surgical history, which of the following activities to be the MOST difficult for the patient following their amputation?

ambulating in the parallel bars

A PTA provides pre-operative instructions to a patient scheduled for LE amputation. Which of the following is the MOST common cause of LE Amputation?

Peripheral vascular disease

What reflex is often associated with completion of the milestone of rolling from prone to supine in infants?

Moro reflex

A patient is scheduled for surgical removal of one toe and the metatarsal. What type of lower extremity amputation is this?

Syme amputation

A 12-month-old child with cerebral palsy demonstrates an abnormal persistence of the positive support reflex. During therapy this would MOST likely interfere with:

Standing activities

Your patient is 55 years old male with a diagnosis of MS. The PT asked you to perform a Functional Reach Test on this patient. The test revealed that the patient is not at risk of falling. What would likely be the quantitative value of this test?

14.5-17 inches

Your patient is recovering from a stroke. The patient displays a strong flexor synergy of the right lower extremity. You would expect this patient to display:

Hip flexion, adduction, ER, knee flexion, DF and eversion

Which of the following is the least common complaint from patients suffering a vestibular disorder?

Auditory changes

A patient with cerebellar dysfunction exhibits signs of dysmetria. Which of the following activities would be the MOST difficult for the patient?

Placing feet on floor markers while walking

A patient s/p right CVA lifts his left arm about 100 degrees and you notice his left fingers extend and abduct. You suspect that this patient is displaying:

Raimistes phenomenon

A patient is s/p right CVA with mild hemiparesis. The patient is able to sit independently and ambulates with an NBQC with supervision for occasional loss of balance and weight shift. Which activity would be most appropriate for this patient?

Sidestepping

A physician indicates that a patient rehabilitating from a cerebrovascular accident has significant perceptual deficits. Which anatomical region would most likely be affected by the stroke?

Somatosensory cortex

The PTA notices that when he turns his patient's head supine, the patient's arm and leg on one side of the body flex, and on the other side of the body it extends. His patient has a diagnosis of a CVA. The PTA suspects that the patient may have a

Homolateral synkinesis

Which of the following may be an appropriate activity when treating a patient with Down's syndrome?

Gentle rocking while having the child do quadricep exercises

According to Brunnstrom, if a patient with a CVA has strong synergistic patterns of movement with no isolated muscle contractions would be in what stage of recovery?

Stage 1

The PTA resists hip add on the unaffected side in order to elicit hip add on the contralateral side. This describes:

Raimiste's Phenomenon

When examining pressure tolerance areas of a residual limb with a quadrilateral socket prosthesis, which areas should the assistant examine with the device off?

Ischial tuberosity and lateral sides of the residual limb

For a patient recovering from acute stroke with a flaccid upper extremity, what is the most appropriate positioning strategy when in bed?

Side-lying on the sound side with the affected shoulder protracted and UE extended resting on a pillow

What activity would be most appropriate for a patient with right hemiparesis who is ambulatory and showing good recovery with the lower extremity moving out of an extensor synergy pattern?

Standing, picking the foot up then moving it behind and slowly lowering it

What would a patient with strong bilateral LE extensor spasticity in the typical distribution of antigravity muscles be expected to demonstrate?

Sacral sitting with increased extension and adduction of LE's

What is muscle activation of an involved extremity due to intense action of an uninvolved muscle or groups of muscles called?

Overflow

To facilitate functional capabilities in children with considerable developmental delay and persistence of the tonic labyrinthine reflex, where is the BEST position to practice reaching for objects?

Prone

For a patient with Down syndrome, which intervention promotes increased muscle tone?

Perform slow, rhythmic movements

To inhibit the flexion synergy pattern in the right UE of a patient post-traumatic brain injury during functional activities, how should the PTA position the right side?

Shoulder into medial rotation, elbow into extension, and forearm into pronation

A common deviation observed in boys with Duchenne's muscular dystrophy when standing from the floor is?

Use of the UE's to push on the knees and "walk" hands up the legs

How is a child with severe autism likely to react to a change in routine at school?

Having a tantrum, screaming, displaying stereotypical behaviors such as hand flapping, or social withdrawal

Where would the stimulus be applied to test the flexor withdrawal reflex?

Forefoot with the lower extremity in flexion

By six months of age, which activity would typically not occur assuming normal development?

Rolling prone to spine

When testing reflexes in a 5-month-old patient with a sudden head extension to provoke a startle reaction, which reflex is most likely being tested?

Moro Reflex

What milestone would a four-month-old infant be expected to have achieved?

Lift head in supine

Increased flexor tone in the UE's and extensor tone in the LE's when the child's head was flexed is a positive sign for which of the following reflexes?

STNR

According to Brunnstrom, what is an appropriate treatment emphasis for a neurological patient?

Limb synergies are a necessary intermediate stage of recovery and the patient should be encouraged to use limb synergy patterns

During ambulation, a patient post-stroke with a hypotonic left upper extremity should have the left UE in which position?

In a sling in shoulder adduction and elbow flexion

What term describes the proprioceptive neuromuscular facilitation technique pattern of active movement of the LE in extension, adduction, and lateral rotation?

D2 flexion

When testing the tonic labyrinthine reflex in a patient positioned in supine, what would be considered a positive response?

Increased flexor tone in the UEs and extensor tone in the LE's

By observing the gait of a patient with a prosthesis, inadequate suspension resulting in distal residual limb skin issues is described as?

Pistoning of the socket

What test is being performed when a patient is asked to stand heel to toe, cross their arms over their chest, and close their eyes?

Sharpened Rhomberg

Which test assesses dynamic balance?

WOFEC

A patient with an AKA exhibiting forward trunk flexion during ambulation may be compensating for?

Weak hip flexors

Which of the following is not a contraindication for lumbar traction?

TMJ dysfunction

For a patient with a flexion bias - flexion syndrome, which of these passive positioning techniques could be used to relieve their symptoms?

Prone positioning without a pillow under the abdomen

Which ethical principle requires that the healthcare worker not do anything to cause the patient harm?

Nonmaleficence

What type of prostaglandin production causes inflammation and production?

COX-2

Study Notes

Here are the study notes for the text:

Physical Therapist Assistant Program

Prosthetics and Orthotics

  • Quadrilateral socket: a type of prosthetic socket used for transfemoral amputations
  • Areas to examine for pressure tolerance on a residual limb: ischial tuberosity, lateral sides of the residual limb, distolateral end of the femur, and ischial seat
  • Types of orthoses:
    • AFO (Ankle-Foot Orthosis): used to control ankle and foot movement
    • KAFO (Knee-Ankle-Foot Orthosis): used to control knee, ankle, and foot movement
    • HKAFO (Hip-Knee-Ankle-Foot Orthosis): used to control hip, knee, ankle, and foot movement
    • TLSO (Thoracolumbosacral Orthosis): used to control thoracic and lumbar spine movement
    • C-LSO (Cervical-Lumbosacral Orthosis): used to control cervical and lumbar spine movement

Neurological Rehabilitation

  • Types of reflexes:
    • Flexor withdrawal reflex: a reflexive response to a noxious stimulus
    • Extensor thrust reflex: a reflexive response to a sudden movement
    • Moro reflex: a reflexive response to a sudden change in position
    • Tonic labyrinthine reflex: a reflexive response to changes in posture
  • Abnormal reflexes:
    • STNR (Symmetrical Tonic Neck Reflex): a reflexive response to neck movements
    • ATNR (Asymmetrical Tonic Neck Reflex): a reflexive response to neck movements
  • Types of cerebral palsy:
    • Spastic paraplegia: characterized by increased tone in the legs
    • Spastic hemiplegia: characterized by increased tone in one side of the body
    • Ataxic paraplegia: characterized by decreased coordination and balance in the legs
  • Assessment tools:
    • Berg Balance Scale: a tool used to assess balance and risk of falling
    • TUG (Timed Up and Go) test: a tool used to assess mobility and balance

Gait and Balance

  • Phases of gait:
    • Heel strike: the phase of gait where the heel strikes the ground
    • Foot flat: the phase of gait where the entire foot is in contact with the ground
    • Push-off: the phase of gait where the foot pushes off the ground
  • Muscle activity during gait:
    • Quadriceps: active during loading response and terminal swing
    • Hamstrings: active during terminal swing and deceleration
    • Gluteus maximus: active during terminal swing

Motor Control

  • Types of motor control:
    • Proprioceptive neuromuscular facilitation (PNF): a technique used to facilitate movement and strengthen muscles
    • Motor control: a technique used to improve coordination and control of movement
  • PNF patterns:
    • UE D1 flexion: a pattern used to facilitate flexion of the upper extremity
    • UE D1 extension: a pattern used to facilitate extension of the upper extremity
    • LE D1 flexion: a pattern used to facilitate flexion of the lower extremity
    • LE D1 extension: a pattern used to facilitate extension of the lower extremity

I hope these study notes are helpful! Let me know if you have any questions or need further clarification.Here are the study notes for the text:

Developmental Assessment

  • A 6-month-old child should be able to roll from prone to supine.
  • A 12-month-old child should be able to sit with support, pull to stand, and use a spoon.

Reflexes

  • The Tonic Labyrinthine Reflex (TLR) is exhibited when the infant has an extensor tone in supine and flexor tone in prone.
  • The Asymmetric Tonic Neck Reflex (ATNR) is exhibited when the infant extends the arm and leg on the side to which the head is turned.
  • The Positive Supporting Reaction (PSR) is exhibited when the infant supports their body on their arms when in prone.

Pediatric Assessment

  • By 5 months, babies should crawl on their hands and knees.
  • By 2 years, children should be able to catch a large ball most of the time.

Amputations

  • A Syme amputation is a type of lower extremity amputation.
  • The most common cause of lower extremity amputation is peripheral vascular disease.

Physical Therapy

  • When wrapping an amputation, use a figure-eight pattern and avoid wrinkles.
  • A rigid dressing promotes circulation and healing and allows for early ambulation with a pylon.

Neurological Conditions

  • A flexion pattern of the involved upper extremity can facilitate flexion of the involved lower extremity (Raimiste's phenomenon).
  • A transradial amputation is functionally preferred over a wrist disarticulation.

Orthopedic Conditions

  • A disk lesion is a rupture of the nucleus pulposus into the posterior longitudinal ligament or above or below the disk space.
  • Spondylosis is a degenerative condition of the spine.

Posture

  • A lordotic posture can be caused by mobility impairments in the iliopsoas and rectus femoris.
  • A kyphotic posture can be caused by mobility impairments in the thoracic spine.

Medications

  • Opioid drugs can cause drowsiness, confusion, and generalized muscle weakness as side effects.
  • Glucocorticoid agents can be used to treat rheumatic diseases and respiratory disorders.
  • Non-opioid agents can be used to treat pain.

Prostaglandin Production

  • COX-1 and COX-2 are two types of prostaglandin production, with COX-2 causing inflammation.

Medication Side Effects

  • Muscle relaxants can cause drowsiness and generalized muscle weakness as side effects.Here are the study notes:
  • Phenytoin (Dilantin)*
  • May be prescribed to reduce tone in spinal cord injury, CVA or MS patients
  • Antispasticity Agent*
  • Prescribed to reduce tone in spinal cord injury, CVA or MS patients
  • Diuretic Agents*
  • Used to treat hypertension
  • May cause postural hypotension
  • Beta Blocker Agent*
  • Indications: angina, hypertension, arrhythmias
  • Not indicated for thromboembolism
  • Medication Side Effects*
  • Phenytoin: may cause physical dependence
  • Opioid agents: may cause physical dependence
  • Diuretic agents: may cause postural hypotension
  • Ethical Principles*
  • Beneficence: do good
  • Nonmaleficence: do no harm
  • Justice and veracity: fairness and truthfulness
  • Confidentiality: respect for patient autonomy
  • PTA Core Values*
  • Altruism: putting patient's interest first
  • Responsibility: accountability for actions
  • Integrity: honesty and fairness
  • Not: Judgement (not a core value)
  • Patient's Bill of Rights*
  • Right to privacy concerning medical care
  • Right to refuse any and all treatment
  • Young patients may remain on parent's insurance until age 26
  • Insurance companies may not discriminate against children with preexisting conditions
  • Standards of Ethical Conduct for PTAs*
  • Respect patient's rights and dignity
  • Provide services independently
  • Provide services within the limits of the law
  • Make judgments commensurate with qualifications
  • Pharmacology*
  • Pharmacodynamics: study of drug effects on the body
  • Pharmacokinetics: study of drug movement in the body
  • Bioavailability: percentage of drug that reaches systemic circulation
  • Half-life: time for drug concentration to decrease by half
  • Medication Administration*
  • Parenteral: injection, not oral
  • Enteral: oral, through the gastrointestinal tract
  • Bioavailability: percentage of drug that reaches systemic circulation
  • Pharmacological Agents*
  • Albuterol: treats exercise-induced asthma
  • Thrombolytic agents: treats myocardial infarction, not hemorrhagic stroke
  • Diuretic agents: may cause postural hypotension
  • Narcotic medications: may cause physical dependence
  • Movement and Balance*
  • Flexor synergy: flexion, abduction, ER, knee flexion, DF, inversion
  • Associated reactions: flexion of uninvolved UE facilitates extension of involved UE
  • Raimiste's phenomenon: extension of uninvolved LE facilitates flexion of involved LE
  • Homolateral synkinesis: abnormal movement patterns on the same side of the body
  • Balance and Coordination*
  • Functional Reach Test: patient at risk of falling if <10 inches
  • Timed Up and Go test: measures balance and mobility
  • Sharpened Romberg test: measures balance and coordination
  • Neurological Rehabilitation*
  • CVA: may cause perceptual deficits, dysarthria, and dysphagia
  • Parkinson's disease: motor deficits, rigidity, bradykinesia
  • Cerebellar dysfunction: dysmetria, ataxia, intention tremor

This quiz assesses knowledge of prosthetic care for patients with transfemoral amputation, including pressure tolerance areas of the residual limb. It is part of the Physical Therapist Assistant Program at Kingsborough Community College.

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