By Susan J. Garrison MD

Revised and up to date for its moment variation, this renowned guide is a concise but entire quickly reference for the review and remedy of actual disabilities. specialists from best associations current very sensible, problem-oriented directions in 23 subject components. themes are indexed alphabetically by way of common analysis and chapters have a constant, easy-to-follow association.

This edition's brand-new bankruptcy on handbook medication covers evaluate and analysis; formula of the actual treatment prescription; follow-up; stretch vs. energy vs. issue of actions; and time frames for every step of the therapy plan. different new chapters conceal pediatric rehabilitation, geriatric rehabilitation, and prosthetics and orthotics.

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DEVELOPED BY: HINES PACT PROGRAM 1091-03 CH03 03/19/03 15:14 Page 30 30 3. Amputations Most prostheses are custom fitted and fabricated and are made with total contact sockets. ” The cast is removed and filled with a plastic material to form a “positive” replica of the limb, which serves as the model on which the synthetic prosthetic socket is molded. Prosthetic fabrication is aided by technologic advancements, thus improving the accuracy of socket fit and reduction in the fabrication time. Prostheses are either preparatory or definitive.

However, large neuromas, or those in critical locations where they are subjected to pressure or shear stress, may be painful and interfere with prosthetic gait. Treatment approaches include local injection with steroid, ultrasound, or rarely surgical excision and/or revision of the amputation. Painful residual limbs may result from factors not directly related to the amputation or prosthesis. A lumbar herniated nucleus pulposus (HNP) may cause pain to radiate down the residual limb. Several of the usual clues used to diagnose this condition may be missing, including lower lumbosacral dermatomes for assessing sensation, distal muscles for assessing strength, or the patellar or Achilles tendons for assessing reflexes.

Amputations The residual limb is measured from the medial joint line of the knee rather than the tibial tuberosity. A bone length of less than 2 in. provides such a short lever arm that special prosthetic fabrication techniques may be needed. Residual tibial length of more than 8 in. makes standard fitting difficult. Extremely long residual limbs in TTAs have poor muscle coverage, because the distal one third of the lower leg is covered mostly by tendons, which predisposes to skin breakdown. In addition, the lever arm of the limb is longer, resulting in greater force on the distal skin during gait and compounding the breakdown problem.

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Handbook of physical medicine and rehabilitation : the by Susan J. Garrison MD
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