Prosthetic training

1. What is the basic motion for opening the terminal device on a transradial prosthetic?
2. What are activities that are important to practice for a unilateral transradial amputee?
3. How is elbow flexion and extension achieved in a transhumeral prosthetic?
4. How is the TD operated with a transhumeral prosthetic?

Answers:
1. Forward flexion of the humerus.
2. Two handed activities such as cutting food or tying shoelaces.
3. Flexion of the elbow is achieved by humeral flexion, and extension of the elbow is achieved by elbow extension back to neutral.
4. When the elbow is locked, use additional humeral flexion to open or close the TD.

Amputee care and rehab

1. What are the most important three things to consider in a clinical decision for a prosthesis?
2. What does preprosthetic therapy include?
3. What types of rotation are most seriously affected in UE amputation?

Answers:
1. Amputation level, proximal muscle strength and ROM, general health.
2. Stump shrinkage, muscle strength, ROM, postural problems, desensitization, scar mobilization, and home exercise program.
3. Humeral rotation in transhumeral amputees, and forearm rotation in transradial amputees.

Above elbow prostheses

1. What are two types of elbow joints? Which is preferred?
2. What sort of elbow locking system is used in elbow disarticulations?
*3. What harness designs are used most frequently for transhumeral prostheses?

Answers:
1. Internal and external locking elbow. Internal elbow is preferred because of greater durability and used in level of amputation 4 cm or more proximal to the level of the epicondyle. External elbow is used for longer limbs.
2. External locking.
3. Modifications of the figure-8 and chest-strap patterns used with transradial prostheses.

Below elbow amputation prostheses

1. What is the difference between a split socket and a Muenster socket?
2. What are different harness suspension and control systems?
3. What are two kinds of control-cable systems?

Answers:
1. A split socket is used with very short stumps and encases the residual limb, attempted to a separate forearm shell to which the wrist unit and terminal device are attached. The Muenster socket is self-suspended, encapsulating the olecranon and humeral epicondyle with greater ease of use.
2. A figure-8 harness is most commonly used, with an axilla loop, worn at the normal side, which acts as a reaction point to transmit body force to the terminal device. The figure-9 is often used with the Muenster socket and is used only for controlling the TD and not for suspension. The chest-strap with shoulder saddle is used if an axilla loop can't be tolerated or for heavy lifting.
3. The Bowden control cable system is used with the purpose of operating the terminal device using body power. The dual-control cable system is used with very short transradial limbs with locking elbows, so can flex the elbow with the elbow is unlocked and operate the TD whe the elbow is locked.

Terminal devices

1. What are the advantages and disadvantages of a passive TD?
2. What is a three-jaw chuck pinch?
*3. What is the difference between a voluntary-opening and voluntary-closing terminal device?
4. What are externally powered TD?
*5. What are the two types of prosthetic wrists?

Answers:
1. Lighter, but with no functional mechanism and no grasp, intended for cosmetics only. Flexible passive TD may absorb shock.
2. Grip with thumb, index, and middle fingers, which is provided by a prosthetic hand.
3. VO is most common and practical type, powered by proximal muscles to open the TD against springs. VC is most physiological, but is heavier and less durable.
4. Controlled by switches or myoelectric signals and powered with energy from external batteries.
5. Friction and locking. Friction permits pronation and supination of TD and hold it in selected position via friction. A locking wrist permits manual rotation then locks the TD in the selected position, which is an advantage in that it prevents inadvertent rotation of the TD when a heavy object is grasped.

Upper limb prosthetics

1. What is the benefit of a wrist disarticulation over a BEA?
2. What is the most common level of arm amputation?
3. What are the pros and cons of elbow disarticulation?
4. What are two methods of suspension of a transhumeral amputation?
5. What sort of prosthesis is generally used in a forequarter amputation?

Answers:
1. Spares distal radial-ulnar articulation --> full forearm supination and pronation.
2. Transradial.
3. Pros include simpler surgery, improved prosthesis self-suspension. Cons include the cosmetic appearance and inability to use an externally powered elbow.
4. Figure-8 or shoulder saddle and chest strap.
5. Passive ultralight cosmetic prosthesis due to poor outcome with functional prosthesis.

Gait pathology

1. What is the cause of foot slap?
2. What is the cause of genu recurvatum?
3. What is the cause of excessive trunk extension?
4. What is the cause of excessive knee flexion?
5. What is the cause of pelvic drop?
6. What is the cause of a waddling gait?
7. What is the cause of excessive foot pronation?
8. What is the cause of steppage gait?
9. What is the cause of hip circumduction?
10. What is the cause of hip hike?

Answers:
1. Moderately weak ankle dorsiflexors.
2. Weak, short or spastic quads, hamstring weakness, Achilles contracture, PF spasticity.
3. Weak hip extensors or flexors, hip pain, decreased knee ROM.
4. Hamstring contracture, increased ankle DF, weak PF, long limb, hip flexion contracture.
5. Contralateral gluteus medius weakness.
6. Bilateral GM weakness.
7. Compensationed forefoot or rearfoot varus deformity, uncompensated valgus deformity, pes planus, decreased ankle DF, increased tibial varum, long limb, uncompensated internal rotation of tibia or femur, weak tibialis posterior.
8. Severely weak DF, equinus deformity, PF spasticity.
9. Long limb, abductor muscle shortening or overuse.
10. Long limb, weak hamstring, quad lumborum shortening.