CPO Patient Management & Follow-Up 3 — Questions and Answers
Question 1: A bilateral lower limb amputee returns for a follow-up reporting fatigue during ambulation. Which energy expenditure factor should the practitioner evaluate first?
- Prosthetic foot category and dynamic response (Correct answer)
- Cosmetic cover weight
- Pylon material
- Color of the suspension sleeve
Correct answer: Prosthetic foot category and dynamic response
Prosthetic foot selection directly influences energy return and metabolic cost of ambulation in bilateral amputees.
Question 2: Which patient complaint during follow-up most strongly indicates the need for a complete socket replacement rather than a modification?
- Mild discomfort at the patellar tendon bar
- Total contact loss with >6 socks needed for fit (Correct answer)
- Minor pistoning correctable with sleeve
- Slight anterior distal skin redness
Correct answer: Total contact loss with >6 socks needed for fit
Requiring more than 5 ply of socks indicates significant volume loss that warrants fabricating a new socket rather than temporary accommodation.
Question 3: During a follow-up with a patient using a myoelectric upper limb prosthesis, the practitioner observes delayed terminal device response. The most likely cause is:
- Low residual limb volume
- Inadequate electrode contact with skin (Correct answer)
- Incorrect wrist flexion unit
- Worn suspension harness
Correct answer: Inadequate electrode contact with skin
Poor electrode-skin contact is the most common cause of delayed or inconsistent myoelectric signal response.
Question 4: A patient at a 12-month follow-up reports phantom limb pain that has worsened since initial fitting. The appropriate practitioner response is:
- Increase prosthesis use time to reduce phantom pain
- Document the complaint and refer to the treating physician (Correct answer)
- Adjust socket volume and reassess in 2 weeks
- Prescribe a different prosthetic foot design
Correct answer: Document the complaint and refer to the treating physician
Worsening phantom limb pain requires physician referral for medical management, as it falls outside the prosthetist's scope to treat.
Question 5: When conducting a follow-up gait analysis for a patient with a transtibial prosthesis, a shortened step length on the sound side is most likely caused by:
- Excessive prosthetic foot plantarflexion resistance (Correct answer)
- Weak sound limb hip extensors
- Overly long prosthesis
- Incorrect socket suspension type
Correct answer: Excessive prosthetic foot plantarflexion resistance
Excessive plantarflexion resistance at the prosthetic ankle limits forward progression, causing a shortened contralateral step.
Question 6: A patient who is a K2 ambulator presents at follow-up requesting a microprocessor knee. The practitioner's most appropriate action is:
- Order the component based on patient request
- Explain that K2 functional level does not meet criteria for microprocessor knees (Correct answer)
- Fit the patient and submit for insurance approval without documentation
- Deny the request without explanation
Correct answer: Explain that K2 functional level does not meet criteria for microprocessor knees
Microprocessor knees are indicated for K3/K4 ambulators; a K2 classification does not meet the clinical criteria for this technology.
Question 7: During a upper limb prosthesis follow-up, a patient using a body-powered hook reports difficulty with fine motor tasks. The first adjustment to evaluate is:
- Terminal device opening force via rubber band count (Correct answer)
- Harness attachment point location
- Elbow unit lock mechanism
- Wrist rotator torque
Correct answer: Terminal device opening force via rubber band count
The number of rubber bands on a voluntary-opening hook directly determines the pinch force and precision of grip.
CPO Patient Management & Follow-Up 3
A bilateral lower limb amputee returns for a follow-up reporting fatigue during ambulation.
Which energy expenditure factor should the practitioner evaluate first?