CPT Patient Assessment & Clinical Evaluation 3 — Questions and Answers
Question 1: The Berg Balance Scale (BBS) is used in prosthetic assessment primarily to:
- Measure residual limb volume changes
- Quantify fall risk and balance performance (Correct answer)
- Determine socket fit adequacy
- Classify ambulatory K-level
Correct answer: Quantify fall risk and balance performance
The Berg Balance Scale is a 14-item functional balance tool used to quantify static and dynamic balance, helping identify fall risk in prosthetic users.
Question 2: A patient with a transfemoral amputation secondary to peripheral vascular disease has an ABI of 0.4 on the contralateral limb. This finding should prompt the clinical team to:
- Proceed with standard prosthetic fitting without modification
- Monitor closely and coordinate vascular care to protect the remaining limb (Correct answer)
- Defer all prosthetic intervention indefinitely
- Increase the weight-bearing on the prosthetic side
Correct answer: Monitor closely and coordinate vascular care to protect the remaining limb
An ABI of 0.4 indicates severe peripheral arterial disease in the remaining limb; close monitoring and vascular co-management are essential to prevent contralateral limb loss.
Question 3: When documenting residual limb shape for socket design, a 'dog-eared' appearance refers to:
- Redundant soft tissue folds at the distal end or corners of the closure (Correct answer)
- Excessive bony prominence at the fibular head
- Scar contracture pulling skin toward the bone
- Adequate conical shaping of the residual limb
Correct answer: Redundant soft tissue folds at the distal end or corners of the closure
Dog-ears are redundant tissue folds often seen at surgical closure corners; they create fitting challenges and pressure concentration in the prosthetic socket.
Question 4: The Two-Minute Walk Test (2MWT) in prosthetic rehabilitation is primarily used to assess:
- Socket volume stability over time
- Functional walking endurance and community ambulation capacity (Correct answer)
- Hip and knee range of motion
- Upper extremity strength for crutch use
Correct answer: Functional walking endurance and community ambulation capacity
The 2MWT measures the distance a patient walks in two minutes, reflecting walking endurance and correlating with community ambulation capability for prosthetic users.
Question 5: A patient with a below-elbow amputation reports difficulty gripping objects with their body-powered prosthesis. During assessment, limited terminal device opening is observed. The FIRST step in clinical evaluation is:
- Replace the terminal device immediately
- Assess harness tension and excursion available (Correct answer)
- Adjust the wrist unit flexion angle
- Refer directly to occupational therapy
Correct answer: Assess harness tension and excursion available
Insufficient terminal device opening in a body-powered prosthesis is most commonly caused by inadequate harness excursion or tension, which should be assessed before replacing components.
Question 6: Which of the following is the MOST appropriate tool for measuring residual limb volume changes over time in a transtibial amputee?
- Visual inspection and tactile feedback
- Circumferential measurements at set intervals with a tape measure (Correct answer)
- Patient-reported socket comfort only
- Radiographic imaging of the limb
Correct answer: Circumferential measurements at set intervals with a tape measure
Serial circumferential measurements at standardized intervals provide an objective, reproducible method to track volume changes that affect socket fit.
Question 7: During the initial evaluation of a new upper limb amputee, the clinician notes myoelectric signal strength is weak bilaterally. The most likely contributing factor is:
- Improper electrode placement during testing
- Patient anxiety and muscle guarding reducing voluntary contraction (Correct answer)
- A need for immediate surgical revision
- Normal finding requiring no clinical action
Correct answer: Patient anxiety and muscle guarding reducing voluntary contraction
Anxiety, guarding, and unfamiliarity with voluntary muscle contraction can suppress myoelectric signal strength during initial evaluation; training typically resolves this.
CPT Patient Assessment & Clinical Evaluation 3
The Berg Balance Scale (BBS) is used in prosthetic assessment primarily to: