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P and O

Prosthesis preparation and fitting

Pre-amputation and pre-prosthetic preparation, fitting and checking a prosthesis

12 questions 2 source pages 1 fact-check flags

Images appear with the first question taken from each source page — tap a question to open it.

12 questions
Q1What three factors determine good function after lower limb amputation?▸
  • Patient
  • Amputated stump
  • Prosthesis
Q2How is the patient optimized pre-operatively and intra-operatively?▸
  • Pre-op: optimize patient physically and psychologically
  • Intra-op: optimal length
  • Intra-op: optimal bulk
  • Intra-op: soft tissue to prevent neuroma and maintain muscle balance
Q3What post-operative stump care is required after amputation?▸
  • Swelling control: differential crepe, elastic stocking
  • Prevent contracture
  • Skin desensitization
Q4When does pre-prosthetic training start and what is a preparatory prosthesis for?▸
  • When stump condition is stable, usually around 4 weeks
  • Preparatory prosthesis allows stump maturation (till few months post-op)
Q5What factors determine the choice of socket and suspension at prosthetic fitting?▸
  • Patient factor
  • Finance/cost
  • Surgical factor
  • P&O factor
Q6What are the final stages of prosthetic rehabilitation?▸
  • Proper walking mechanism taught by the P&O
  • Good care of the stump
  • Change to definitive prosthesis
Q7What is the timeline from amputation to normal gait?▸
  • Off stitches at 2 weeks
  • Stump bandages from 2-4 weeks
  • Temp prosthesis 4-6 weeks
  • Stand with prosthesis 6-10 weeks
  • Normal gait at 12 weeks
Q8What is the Amputee Mobility Predictor (AMP)?▸
  • Gailey et al 1999
  • Predicts patient mobility with and without prosthesis by demo + PE - 21 tasks
  • Used to predict K level
Q9What is assessed in the K level (Medicare functional classification) assessment?▸
  • Actual assessment of patient (CAT)
  • Transfer
  • Ambulation - level ground, low level barriers
  • Cadence = steps per min
Q10Define K0 and K1 functional levels and their prosthetic implications.▸
  • K0 - fail to transfer/ambulate even with assistance; prosthesis does not improve QoL
  • K1 - fixed cadence on level ground (household ambulator)
  • K1 components: manual lock knee, SACH foot
Q11What defines K2 and what prosthetic components are used?▸
  • overcome low lever barrier (low level barrier) (limited community ambulator)
  • Components: four bar polycentric/stance phase control, single axis foot
Q12What defines K3 and K4 functional levels?▸
  • K3 - variable cadence over most barriers (community ambulator) --> hydraulic, energy storage foot
  • K4 - active adults/athlete

Fact check

Amputee Mobility Predictor (AMP) is attributed to Gailey et al 1999 and has 21 tasks — citation year — The 21-item AMP (with and without prosthesis) was published by Gailey et al in Arch Phys Med Rehabil 2002;83:613-627, developed from earlier work; the K-level system was adopted by Medicare in 1995 — (medium confidence) — source
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