- Email: [email protected]
2006 SAE-P: Limb Deficiency and Prosthetic Management
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2006 SAE-P: Limb Deficiency and Prosthetic Management Michelle S. Gittler, MD, Thomas S. Kiser, MD, Atul T. Patel, MD Clinical Activity 1.1 1. The most common cause of congenital limb deficiency is (a) viral infection. (b) vascular condition. (c) teratogenic agent. (d) amniotic bands. Ref: Fisk JR, Smith DG. The limb-deficient child. In: Smith DG, Michael JW, Bowker JH, editors. Atlas of amputations and limb deficiencies: surgical, prosthetic, and rehabilitation principles. 3rd ed. Rosemont: American Academy of Orthopaedic Surgeons; 2004. p 773-7. Clinical Activity 1.1 2. A child with a congenital transverse radial limb deficiency should have an initial prosthesis fit at what developmental stage? (a) At the time of starting kindergarten (b) As soon as possible after birth (c) At the time of first sitting independently (d) At the time of initially walking Ref: Activity 1.1. Clinical Activity 1.1 3. Initial management of bony overgrowth of the residual limb includes (a) pain management. (b) surgical excision. (c) embolization via interventional radiology. (d) socket revision. Ref: Fisk JR, Smith DG. The limb-deficient child. In: Smith DG, Michael JW, Bowker JH, editors. Atlas of amputations and limb deficiencies: surgical, prosthetic, and rehabilitation principles. 3rd ed. Rosemont: American Academy of Orthopaedic Surgeons; 2004. p 773-7. Clinical Activity 1.2 4. The major disadvantage of knee disarticulation amputation is (a) tendency for bony overgrowth of the residual limb. (b) less stability in ambulation compared with transfemoral amputation. (c) prosthesis is cosmetically unfavorable. (d) skin is more fragile than with transtibial amputation. Ref: Cummings DR, Russ R. Knee disarticulation: prosthetic management. In: Smith DG, Michael JW, Bowker JH, editors. Atlas of amputations and limb deficiencies: surgical, prosthetic, and rehabilitation principles. 3rd ed. Rosemont: American Academy of Orthopaedic Surgeons; 2004. p 525.
Educational Activity 1.3 6. Which foot is indicated for a transtibial amputee who is at the K2 level? (a) Dynamic response (b) Solid ankle, cushioned heel (c) Multiaxis (d) Single axis Ref: SC Jamieson, AJ Davis. Prosthetics. In: CM Brammer, MC Spires, editors. Manual for clinical problems in physical medicine and rehabilitation. Philadelphia: Hanley & Belfus; 2001. p 414. Educational Activity 1.3 7. Which statement about locomotion in the amputee is TRUE? (a) Rate of oxygen consumption is greater for amputees than nonamputees. (b) Amputees have slower self-selected velocity of ambulation. (c) Vascular amputees ambulate at the same velocity as traumatic amputees. (d) Etiology of amputation does not affect oxygen consumption in ambulation. Ref: Educational Activity 1.3. Clinical Activity: 1.4 8. Knee buckling in a transtibial amputee most likely occurs when (a) the prosthetic foot is set too anterior. (b) the prosthesis has faulty suspension. (c) the SACH heel is too soft. (d) the prosthesis too short. Ref: Kapp SL. Visual analysis of prosthetic gait. In: Smith DG, Michael JW, Bowker JH, editors. Atlas of amputations and limb deficiencies: surgical, prosthetic, and rehabilitation principles. 3rd ed. Rosemont: American Academy of Orthopaedic Surgeons; 2004. p 388. Educational Activity 2.1 9. What is the most common cause of traumatic amputation in the United States in children? (a) Burn injury (b) Motor vehicle collisions (c) Lawnmower accidents (d) Gunshot injury Ref: Letts M, Davidson D. Epidemiology and prevention of traumatic amputations in children. In: Herring JA, Birch JG, editors. The child with a limb deficiency. Rosemont: American Academy of Orthopaedic Surgeon; 1998. p 235-80.
Educational Activity: 1.3 5. In prosthetics, K levels are used to describe or define (a) activity levels. (b) prosthetic feet. (c) funding levels for prosthesis. (d) etiology of amputation.
Educational Activity 2.1 10. How often may an adolescent with a transverse radial limb deficiency require adjustment of prosthetic fit and alignment? (a) Monthly (b) Every 3 months (c) Every 8 months (d) Annually
Ref: Educational Activity 1.3.
Ref: Activity 2.1.
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Educational Activity 2.2 11. Insidious onset of gait impairment in the aging amputee can usually be attributed to (a) prosthesis modifications. (b) osteoarthritis. (c) vascular claudication. (d) radiculopathy. Ref: Educational Activity 2.2. Educational Activity 2.3 12. Predictive factors for successful prosthetic ambulation in bilateral amputees include (a) being married. (b) age older than 64 years. (c) vascular amputation. (d) transfemoral amputation. Ref: Educational Activity 2.3. Educational Activity 2.4 13. Upper-limb amputations account for what percentage of traumatic amputations? (a) 3% (b) 23% (c) 51% (d) 68% Ref: Educational Activity 2.4. Educational Activity 2.4 14. How soon after traumatic amputation should a bodypowered upper-extremity prostheses be fitted? (a) Immediately (b) Within 30 days (c) After achieving proficiency with “hemi-techniques” (d) On completion of work hardening Ref: Pinzur MS, Angelats J, Light TR, Izuierdo R, Pluth T. Functional outcome following traumatic upper limb amputation and prosthetic limb fitting. J Hand Surg [Am] 1994;19: 836-9. Clinical Activity 3.1 15. Compared with an amputation due to other types of burns, an amputation as the result of an electrical burn is likely to (a) be more distal. (b) require less acute hydration. (c) result in less soft-tissue damage. (d) require more complex reconstructive surgical procedures.
(c) 20 to 25 (d) 25 to 30 Ref: Spires MC. Rehabilitation of patients with burns. In: Braddom RL, editor. Physical medicine and rehabilitation. 2nd ed. Philadelphia: WB Saunders; 2000. p 1321-42. Clinical Activity 3.1 17. Heterotopic ossification can occur after a burn injury, and the most common site of formation after a burn is the (a) shoulder. (b) elbow. (c) hip. (d) knee. Ref: Richards AM, Klaassen MF. Heterotopic ossification after severe burns: a report of three cases and review of the literature. Burns 1997;23:64-8. Educational Activity 3.2 18. A 35-year-old man has a massive crush injury to his left leg in a motor vehicle collision. The biggest barrier to limb salvage is (a) ischemic changes from injured blood vessels. (b) multiple areas of fracture. (c) large area of soft-tissue damage. (d) subsequent medical complications. Ref: Educational Activity 3.2. Clinical Activity 3.3 19. What is the most common problem with prosthetic socks impregnated with silicone? (a) Hypertrophic scar can develop under the liner. (b) They are unable to accommodate swelling. (c) Shear with the liner can be problematic. (d) They are not durable and may need frequent replacement. Ref: Davidson J, Champion S, Cousins R, Jones L. Rehabilitation of a quadruple amputee subsequent to electrical burns sustained whilst hang gliding. Disabil Rehabil 2001; 23:90-5. Clinical Activity 3.3 20. What factors, after a burn, limit use of a body powered upper-extremity prosthesis? (a) Phantom limb pain (b) Axillary and shoulder region scarring (c) Prosthetic weight and stiffness (d) Multiple amputations
Ref: (a) Yakuboff KP, Kurtzman LC, Stern PJ. Acute management of thermal and electrical burns of the upper extremity. Orthop Clin North Am 1992;23:161-9. (b) Hussmann J, Kucan JO, Russell RC, Bradley T, Zamboni WA. Electrical injuries—morbidity, outcome and treatment rationale. Burns 1995;21:530-5.
Ref: Huang ME, Levy CE, Webster JB. Acquired limb deficiencies. 3. Prosthetic components, prescriptions, and indications. Arch Phys Med Rehabil 2001;82(3 Suppl 1): S17-24.
Clinical Activity 3.1 16. A 35-year-old woman is transferred to your rehabilitation service after a 40% body surface area burn. You have ordered custom-fit pressure garments. What pressure (in mmHg) do you want to achieve with the garments? (a) 10 to 15 (b) 15 to 20
Clinical Activity 3.3 21. The main advantage of a medial opening design in a Syme’s prosthesis is that it (a) prevents the bulbous end of the limb from clearing the narrow cross-section of the ankle. (b) reduces the forces around the opening of the prosthesis. (c) uses a flexible inner liner.
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(d) has better cosmesis with greater bulk. Ref: Ayyappa E. Postsurgical management of partial foot and Syme’s amputation. In: Lusardi MM, Nielson CC, editors. Orthotics and prosthetics in rehabilitation. Boston: Butterworth-Heinemann; 2000. p 379-93. Clinical Activity 3.3 22. Your 35-year-old white, female patient with a Syme’s amputation complains of a leg-length difference when she is wearing the prosthesis. What accommodation can be made? (a) Change the socket to a posterior-opening design. (b) Consider a referral to a surgeon for surgical residual limb modification. (c) Provide gait training to help her learn to accommodate the leg-length difference. (d) Change to a low-profile prosthetic foot. Ref: Activity 3.3. Clinical Activity 3.4 23. The most important factor to prevent skin breakdown and bacterial and fungal infection in a residual limb is (a) daily washing of the skin and adequate drying of socket and liners. (b) use of antibacterial soap on the skin daily to decrease the skin’s bacterial count. (c) use of antifungal creams and powders to minimize fungal infections. (d) weekly washing of the socket and the liners. Ref: Levy SW. Skin problems in the amputee. In: Smith DG, Michael JW, Bowker JH, editors. Atlas of amputations and limb deficiencies: surgical, prosthetic, and rehabilitation principles. 3rd ed. Rosemont: American Academy of Orthopaedic Surgeons; 2004. p 701-10. Clinical Activity 4.1 24. Predictors of functional ability after lower-limb amputation include (a) balance on the unaffected leg. (b) memory. (c) age. (d) all the above. Ref: (a) Schoppen T, Boonstra A, Groothoff JW, de Vries J, Goeken LN, Eisma WH. Physical, mental, and social predictors of functional outcome in unilateral lower-limb amputees. Arch Phys Med Rehabil 2003;84:803-11. (b) Fletcher DD, Andrews KL, Butters MA, Jacobsen SJ, Rowland CM, Hallett JW Jr. Rehabilitation of the geriatric vascular amputee patient: a population-based study. Arch Phys Med Rehabil 2001;82:776-9. Clinical Activity 4.1 25. What percentage of elderly dysvascular amputees has at some time incurred a stroke? (a) 20 (b) 35 (c) 10 (d) 5 Ref: O’Connell P, Gnatz S. Hemiplegia and amputation: rehabilitation in the dual disability. Arch Phys Med Rehabil 1989;70:451-4. Arch Phys Med Rehabil Vol 87, Suppl 1, March 2006
Educational Activity: 4.2 26. What is the 5-year mortality rate for a person with diabetes after sustaining a major lower-limb amputation? (a) 67% (b) 50% (c) 25% (d) 10% Ref: Pandian G, Hamid F, Hammond M. Rehabilitation of the patient with peripheral vascular disease and diabetic foot problems. In: DeLisa J, Gans B, editors. Rehabilitation medicine: principles and practice. 3rd ed. Philadelphia: LippincottRaven; 1998. p 1517-44. Educational Activity: 4.2 27. Approximately what percentage of people with endstage renal disease are alive 5 years after amputation? (a) 25% (b) 20% (c) 15% (d) 5% Ref: (a) Eggers P, Gohdes D, Pugh J. Nontraumatic lower extremity amputations in the Medicare end-stage renal disease population. Kidney Int 1999;56:1524-33. (b) Aulivola B, Hile CN, Hamdan AD, et al. Major lower extremity amputation: outcome of a modern series. Arch Surg 2004;139:395-9; discussion 39. Educational Activity: 4.3 28. The occurrence of phantom limb pain, phantom sensation, and residual limb pain is (a) approximately equal at 6 months after amputation. (b) associated with younger age at the time of amputation. (c) markedly different at 1 year after amputation. (d) dependent primarily on the level of amputation. Ref: Ehde DM, Czerniecki JM, Smith DG, et al. Chronic phantom sensations, phantom pain, residual limb pain, and other regional pain after lower limb amputation. Arch Phys Med Rehabil 2000;81:1039-44. Educational Activity 4.3 29. A residual limb neuroma (a) may be present when the physical examination findings are normal. (b) is usually difficult to detect on imaging studies if less than 1cm in diameter. (c) typically occurs within 1 to 12 months postamputation. (d) all the above. Ref: Henrot P, Stines J, Walter F, Martinet N, Paysant J, Blum A. Imaging of the painful lower limb stump. RadioGraphics 2000;20(Suppl):S219-35. Clinical Activity 4.4 30. Which statement is most accurate about psychosocial adjustment after amputation? (a) There is an increased rate of anxiety compared with the general population. (b) Comorbidities have a negative impact on adjustment. (c) Pain does not interfere with adjustment, because some pain can be productive.
SAE-P, Gittler
(d) Depression typically worsens as time elapses after amputation. Ref: (a) Desmond DM, MacLachlan M. Psychosocial perspectives on postamputation rehabilitation: a review of disease, trauma, and war related literature. Crit Rev Phys Rehabil Med 2004;16:77-93.
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(b) Nissen S, Newman W. Factors influencing reintegration to normal living after amputation. Arch Phys Med Rehabil 1992;73:548-51. (c) Gallagher P, MacLachlan M. Psychological adjustment and coping in adults with prosthetic limbs. Behav Med 1999; 25:117-24.
Arch Phys Med Rehabil Vol 87, Suppl 1, March 2006
2006 SAE-P: Limb Deficiency and Prosthetic Management Michelle S. Gittler, MD, Thomas S. Kiser, MD, Atul T. Patel, MD Clinical Activity 1.1 1. The most common cause of congenital limb deficiency is (a) viral infection. (b) vascular condition. (c) teratogenic agent. (d) amniotic bands. Ref: Fisk JR, Smith DG. The limb-deficient child. In: Smith DG, Michael JW, Bowker JH, editors. Atlas of amputations and limb deficiencies: surgical, prosthetic, and rehabilitation principles. 3rd ed. Rosemont: American Academy of Orthopaedic Surgeons; 2004. p 773-7. Clinical Activity 1.1 2. A child with a congenital transverse radial limb deficiency should have an initial prosthesis fit at what developmental stage? (a) At the time of starting kindergarten (b) As soon as possible after birth (c) At the time of first sitting independently (d) At the time of initially walking Ref: Activity 1.1. Clinical Activity 1.1 3. Initial management of bony overgrowth of the residual limb includes (a) pain management. (b) surgical excision. (c) embolization via interventional radiology. (d) socket revision. Ref: Fisk JR, Smith DG. The limb-deficient child. In: Smith DG, Michael JW, Bowker JH, editors. Atlas of amputations and limb deficiencies: surgical, prosthetic, and rehabilitation principles. 3rd ed. Rosemont: American Academy of Orthopaedic Surgeons; 2004. p 773-7. Clinical Activity 1.2 4. The major disadvantage of knee disarticulation amputation is (a) tendency for bony overgrowth of the residual limb. (b) less stability in ambulation compared with transfemoral amputation. (c) prosthesis is cosmetically unfavorable. (d) skin is more fragile than with transtibial amputation. Ref: Cummings DR, Russ R. Knee disarticulation: prosthetic management. In: Smith DG, Michael JW, Bowker JH, editors. Atlas of amputations and limb deficiencies: surgical, prosthetic, and rehabilitation principles. 3rd ed. Rosemont: American Academy of Orthopaedic Surgeons; 2004. p 525.
Educational Activity 1.3 6. Which foot is indicated for a transtibial amputee who is at the K2 level? (a) Dynamic response (b) Solid ankle, cushioned heel (c) Multiaxis (d) Single axis Ref: SC Jamieson, AJ Davis. Prosthetics. In: CM Brammer, MC Spires, editors. Manual for clinical problems in physical medicine and rehabilitation. Philadelphia: Hanley & Belfus; 2001. p 414. Educational Activity 1.3 7. Which statement about locomotion in the amputee is TRUE? (a) Rate of oxygen consumption is greater for amputees than nonamputees. (b) Amputees have slower self-selected velocity of ambulation. (c) Vascular amputees ambulate at the same velocity as traumatic amputees. (d) Etiology of amputation does not affect oxygen consumption in ambulation. Ref: Educational Activity 1.3. Clinical Activity: 1.4 8. Knee buckling in a transtibial amputee most likely occurs when (a) the prosthetic foot is set too anterior. (b) the prosthesis has faulty suspension. (c) the SACH heel is too soft. (d) the prosthesis too short. Ref: Kapp SL. Visual analysis of prosthetic gait. In: Smith DG, Michael JW, Bowker JH, editors. Atlas of amputations and limb deficiencies: surgical, prosthetic, and rehabilitation principles. 3rd ed. Rosemont: American Academy of Orthopaedic Surgeons; 2004. p 388. Educational Activity 2.1 9. What is the most common cause of traumatic amputation in the United States in children? (a) Burn injury (b) Motor vehicle collisions (c) Lawnmower accidents (d) Gunshot injury Ref: Letts M, Davidson D. Epidemiology and prevention of traumatic amputations in children. In: Herring JA, Birch JG, editors. The child with a limb deficiency. Rosemont: American Academy of Orthopaedic Surgeon; 1998. p 235-80.
Educational Activity: 1.3 5. In prosthetics, K levels are used to describe or define (a) activity levels. (b) prosthetic feet. (c) funding levels for prosthesis. (d) etiology of amputation.
Educational Activity 2.1 10. How often may an adolescent with a transverse radial limb deficiency require adjustment of prosthetic fit and alignment? (a) Monthly (b) Every 3 months (c) Every 8 months (d) Annually
Ref: Educational Activity 1.3.
Ref: Activity 2.1.
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Educational Activity 2.2 11. Insidious onset of gait impairment in the aging amputee can usually be attributed to (a) prosthesis modifications. (b) osteoarthritis. (c) vascular claudication. (d) radiculopathy. Ref: Educational Activity 2.2. Educational Activity 2.3 12. Predictive factors for successful prosthetic ambulation in bilateral amputees include (a) being married. (b) age older than 64 years. (c) vascular amputation. (d) transfemoral amputation. Ref: Educational Activity 2.3. Educational Activity 2.4 13. Upper-limb amputations account for what percentage of traumatic amputations? (a) 3% (b) 23% (c) 51% (d) 68% Ref: Educational Activity 2.4. Educational Activity 2.4 14. How soon after traumatic amputation should a bodypowered upper-extremity prostheses be fitted? (a) Immediately (b) Within 30 days (c) After achieving proficiency with “hemi-techniques” (d) On completion of work hardening Ref: Pinzur MS, Angelats J, Light TR, Izuierdo R, Pluth T. Functional outcome following traumatic upper limb amputation and prosthetic limb fitting. J Hand Surg [Am] 1994;19: 836-9. Clinical Activity 3.1 15. Compared with an amputation due to other types of burns, an amputation as the result of an electrical burn is likely to (a) be more distal. (b) require less acute hydration. (c) result in less soft-tissue damage. (d) require more complex reconstructive surgical procedures.
(c) 20 to 25 (d) 25 to 30 Ref: Spires MC. Rehabilitation of patients with burns. In: Braddom RL, editor. Physical medicine and rehabilitation. 2nd ed. Philadelphia: WB Saunders; 2000. p 1321-42. Clinical Activity 3.1 17. Heterotopic ossification can occur after a burn injury, and the most common site of formation after a burn is the (a) shoulder. (b) elbow. (c) hip. (d) knee. Ref: Richards AM, Klaassen MF. Heterotopic ossification after severe burns: a report of three cases and review of the literature. Burns 1997;23:64-8. Educational Activity 3.2 18. A 35-year-old man has a massive crush injury to his left leg in a motor vehicle collision. The biggest barrier to limb salvage is (a) ischemic changes from injured blood vessels. (b) multiple areas of fracture. (c) large area of soft-tissue damage. (d) subsequent medical complications. Ref: Educational Activity 3.2. Clinical Activity 3.3 19. What is the most common problem with prosthetic socks impregnated with silicone? (a) Hypertrophic scar can develop under the liner. (b) They are unable to accommodate swelling. (c) Shear with the liner can be problematic. (d) They are not durable and may need frequent replacement. Ref: Davidson J, Champion S, Cousins R, Jones L. Rehabilitation of a quadruple amputee subsequent to electrical burns sustained whilst hang gliding. Disabil Rehabil 2001; 23:90-5. Clinical Activity 3.3 20. What factors, after a burn, limit use of a body powered upper-extremity prosthesis? (a) Phantom limb pain (b) Axillary and shoulder region scarring (c) Prosthetic weight and stiffness (d) Multiple amputations
Ref: (a) Yakuboff KP, Kurtzman LC, Stern PJ. Acute management of thermal and electrical burns of the upper extremity. Orthop Clin North Am 1992;23:161-9. (b) Hussmann J, Kucan JO, Russell RC, Bradley T, Zamboni WA. Electrical injuries—morbidity, outcome and treatment rationale. Burns 1995;21:530-5.
Ref: Huang ME, Levy CE, Webster JB. Acquired limb deficiencies. 3. Prosthetic components, prescriptions, and indications. Arch Phys Med Rehabil 2001;82(3 Suppl 1): S17-24.
Clinical Activity 3.1 16. A 35-year-old woman is transferred to your rehabilitation service after a 40% body surface area burn. You have ordered custom-fit pressure garments. What pressure (in mmHg) do you want to achieve with the garments? (a) 10 to 15 (b) 15 to 20
Clinical Activity 3.3 21. The main advantage of a medial opening design in a Syme’s prosthesis is that it (a) prevents the bulbous end of the limb from clearing the narrow cross-section of the ankle. (b) reduces the forces around the opening of the prosthesis. (c) uses a flexible inner liner.
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(d) has better cosmesis with greater bulk. Ref: Ayyappa E. Postsurgical management of partial foot and Syme’s amputation. In: Lusardi MM, Nielson CC, editors. Orthotics and prosthetics in rehabilitation. Boston: Butterworth-Heinemann; 2000. p 379-93. Clinical Activity 3.3 22. Your 35-year-old white, female patient with a Syme’s amputation complains of a leg-length difference when she is wearing the prosthesis. What accommodation can be made? (a) Change the socket to a posterior-opening design. (b) Consider a referral to a surgeon for surgical residual limb modification. (c) Provide gait training to help her learn to accommodate the leg-length difference. (d) Change to a low-profile prosthetic foot. Ref: Activity 3.3. Clinical Activity 3.4 23. The most important factor to prevent skin breakdown and bacterial and fungal infection in a residual limb is (a) daily washing of the skin and adequate drying of socket and liners. (b) use of antibacterial soap on the skin daily to decrease the skin’s bacterial count. (c) use of antifungal creams and powders to minimize fungal infections. (d) weekly washing of the socket and the liners. Ref: Levy SW. Skin problems in the amputee. In: Smith DG, Michael JW, Bowker JH, editors. Atlas of amputations and limb deficiencies: surgical, prosthetic, and rehabilitation principles. 3rd ed. Rosemont: American Academy of Orthopaedic Surgeons; 2004. p 701-10. Clinical Activity 4.1 24. Predictors of functional ability after lower-limb amputation include (a) balance on the unaffected leg. (b) memory. (c) age. (d) all the above. Ref: (a) Schoppen T, Boonstra A, Groothoff JW, de Vries J, Goeken LN, Eisma WH. Physical, mental, and social predictors of functional outcome in unilateral lower-limb amputees. Arch Phys Med Rehabil 2003;84:803-11. (b) Fletcher DD, Andrews KL, Butters MA, Jacobsen SJ, Rowland CM, Hallett JW Jr. Rehabilitation of the geriatric vascular amputee patient: a population-based study. Arch Phys Med Rehabil 2001;82:776-9. Clinical Activity 4.1 25. What percentage of elderly dysvascular amputees has at some time incurred a stroke? (a) 20 (b) 35 (c) 10 (d) 5 Ref: O’Connell P, Gnatz S. Hemiplegia and amputation: rehabilitation in the dual disability. Arch Phys Med Rehabil 1989;70:451-4. Arch Phys Med Rehabil Vol 87, Suppl 1, March 2006
Educational Activity: 4.2 26. What is the 5-year mortality rate for a person with diabetes after sustaining a major lower-limb amputation? (a) 67% (b) 50% (c) 25% (d) 10% Ref: Pandian G, Hamid F, Hammond M. Rehabilitation of the patient with peripheral vascular disease and diabetic foot problems. In: DeLisa J, Gans B, editors. Rehabilitation medicine: principles and practice. 3rd ed. Philadelphia: LippincottRaven; 1998. p 1517-44. Educational Activity: 4.2 27. Approximately what percentage of people with endstage renal disease are alive 5 years after amputation? (a) 25% (b) 20% (c) 15% (d) 5% Ref: (a) Eggers P, Gohdes D, Pugh J. Nontraumatic lower extremity amputations in the Medicare end-stage renal disease population. Kidney Int 1999;56:1524-33. (b) Aulivola B, Hile CN, Hamdan AD, et al. Major lower extremity amputation: outcome of a modern series. Arch Surg 2004;139:395-9; discussion 39. Educational Activity: 4.3 28. The occurrence of phantom limb pain, phantom sensation, and residual limb pain is (a) approximately equal at 6 months after amputation. (b) associated with younger age at the time of amputation. (c) markedly different at 1 year after amputation. (d) dependent primarily on the level of amputation. Ref: Ehde DM, Czerniecki JM, Smith DG, et al. Chronic phantom sensations, phantom pain, residual limb pain, and other regional pain after lower limb amputation. Arch Phys Med Rehabil 2000;81:1039-44. Educational Activity 4.3 29. A residual limb neuroma (a) may be present when the physical examination findings are normal. (b) is usually difficult to detect on imaging studies if less than 1cm in diameter. (c) typically occurs within 1 to 12 months postamputation. (d) all the above. Ref: Henrot P, Stines J, Walter F, Martinet N, Paysant J, Blum A. Imaging of the painful lower limb stump. RadioGraphics 2000;20(Suppl):S219-35. Clinical Activity 4.4 30. Which statement is most accurate about psychosocial adjustment after amputation? (a) There is an increased rate of anxiety compared with the general population. (b) Comorbidities have a negative impact on adjustment. (c) Pain does not interfere with adjustment, because some pain can be productive.
SAE-P, Gittler
(d) Depression typically worsens as time elapses after amputation. Ref: (a) Desmond DM, MacLachlan M. Psychosocial perspectives on postamputation rehabilitation: a review of disease, trauma, and war related literature. Crit Rev Phys Rehabil Med 2004;16:77-93.
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(b) Nissen S, Newman W. Factors influencing reintegration to normal living after amputation. Arch Phys Med Rehabil 1992;73:548-51. (c) Gallagher P, MacLachlan M. Psychological adjustment and coping in adults with prosthetic limbs. Behav Med 1999; 25:117-24.
Arch Phys Med Rehabil Vol 87, Suppl 1, March 2006