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Special Topics
Prosthetics
| Question | Answer |
|---|---|
| Prosthetics | -Replacement of all or part of an extremity |
| Prosthetist | -Health professional who: designs, fabricates, fits, modifies a limb prostheses |
| Types of prostheses | -Foot -Syme's -Transtibial -Transfemoral -Knee & hip disarticulation |
| Partial foot prosthesis | -Plastic socket attached to rigid plate -Cosmetic toe filler pictured |
| Standard components | -Suspension -Liners/socks -Socket -Shank/pylon -Foot/ankle assembly |
| Foot/ankle assembly | -Purpose to stimulate muscle and joint activity -3 purposes of the foot and ankle: ? |
| Foot/ankle assembly: 2 major categories | -Non-articulated vs articulated- related to motion -Non- dynamic vs dynamic response-related to stored energy |
| Foot/ankle assembly: Non-articulated | -No axis between foot and rest of prosthesis= no motion -Lighter, more durable, more attractive -High-heel versions |
| Foot/ankle assembly: Articulated | -Separate foot and lower shank section joined by bolt or cable= motion -Ankle and foot motion controlled by rubber bumpers -May loosen/ make noise |
| Foot/ankle assembly: Non-dynamic | -NO storing of energy -NO give between parts |
| Foot/ankle assembly: Dynamic | -Store & release energy giving some spring or recoil to a step: -used for active people -respond to more time spent on the forefoot -allows for running and jumping |
| Types of foot/ankle assembly | -Solid Ankle Cushion Heel (SACH) -Stationary Attachment Flexible Endoskeleton (SAFE) -FlexFoot & Springlite -Single Axis -Multi-axis -Personal bionics |
| SACH | -Wooden/metal center covered with rubber -Soft heel simulates PF -Non-articulated and non-dynamic |
| SAFE | -Variation of SACH -Good with uneven terrain: Mobile rearfoot in med/lat directions Limited DF/PF bumpers More flexible foot -Heavier/More expensive -Non-articulated but dynamic |
| Flex-foot and Spring-lite | -Long curved carbon fiber band -Non-articulated but more dynamic |
| Single axis | -Most common articulated foot -Limited DF/PF: Bumpers, Toe action, No IV/EV -Commonly used with trans-femoral/-tibial -Non-dynamic |
| Multi-axis | -Moves slightly in all planes with bumpers -Heavier and less durable -Dynamic and non-dynamic versions |
| Personal bionics: Biom | -Mimics muscle function therefore dynamic -Benefits: -Normalize gait speed and energy use -Alleviate comorbidities i.e. LBP/OA -Improve ground adaptation -Patient profile: -190-250 lbs -BKA or AKA -Bluetooth capability settings |
| Shank | -Substitute for human leg -Transmits body weight from the socket to the foot -Not present in Syme's prosthesis |
| Shank: Exoskeletal | -Hollow wood/ plastic -Non-changeable |
| Shank: Endoskeletal | -Without cosmetic cover -Central pylon -Foam rubber cover |
| Sockets | -Plastic receptacle for RL -Vary with: Level of amputation/ Configuration of the limb -Designed for: -Weight-bearing -Assisting circulation -Providing feedback |
| Movement within the socket may cause... | -Skin problems -Abnormal gait -Decreased limb security (i.e. falls) |
| Pressure relief area | -Internal socket concavity |
| Pressure tolerant area | -Internal socket convexity -Not the bottom of the RL |
| BKA | -Fibular head -Anterior tibia: tibial crest/ tibial condyles -Hamstring tendons |
| AKA tendons | -Anteromedial: Adductor longus tendon -Posteromedial: Hamstrings tendon/ Sciatic n -Posterolateral: permit glute max m. function -Anterolateral: rectus femoris tendon |
| AKA: femoral triangle | -Anterior wall over femoral triangle: femoral n, femoral vv, lymphatic vv |
| Common pressure tolerant areas | -BKA: -Patellar tendon and tibial tubercle -Proximal medial tibia and shaft (NOT condyle) -Fibular shaft -Gastrocnemius muscle bulk -AKA: -Ischial tuberosity -Quads/hamstrings muscle bulk (not tendons) |
| Greater surface area tends to be more... | -Pressure tolerant -i.e. large/ flat bony landmarks and muscle bellies |
| Smaller surface area tends to be more... | -Pressure relief -i.e. small/ pointed bony landmarks and thin tendons |
| Socket skin reactions | -Transient redness with pressure tolerant areas -No reddness with pressure relief areas |
| Syme's Socket | -Distal loading -Cut out for bulbous RL -No shank |
| Transtibial Socket: PTB | -Patellar tendon bearing (PTB) -Aligned on shank in slight flexion to: -Increase patellar tendon loading -Prevent genu recurvatum (hyperext) -Prevent RL inferior sliding |
| Transtibial socket: PTB cont... | -Also aligned in slight lateral tilt (genu valgus) to decrease fibular head load |
| Knee Disarticulation Sockets | -Terminantes below ischial tuberosity |
| Transfemoral sockets | -Quadrilateral-most common -Ischial containment |
| Transfemoral Sockets (Quadrilateral) | -Posterior shelf for ischial tuberosity and glutes plus medial dege at same level -Higher anterior wall to push ischial tuberosity onto posterior shelf -Lateral wall same height as anterior for stabilization |
| Transfemoral socket (Ischial containment) | -Coverage for greater stabilization: -Ischial tuberosity -Pubic ramus -Greater trochanter -Mediolateral width narrower yo: …↑ frontal plane stability … minimize bulk between legs -Anterior wall lower |
| Transfemoral sockets: slight flexion to... | -Facilitate hip extensors -Decrease lumbar lordosis -Increase available hip extension ROM for equal step length |
| Hip disarticulation/ hemipelvectomy sockets | -Molded plastic -Weight-bearing on ischial tuberosities and gluteals instead of torso |
| Liners | -Provides protection between skin and socket -Liners: Gel or foam, rolled on/ off, lock or seal into socket |
| Socks | -Cotton, wool, or synthetic fabric -Add more as RL shrinks due to… -Decreased swelling -Atrophy |
| Suspension methods | -Cuff/straps- grip above boney prominences -Thigh Corset -Brim (edge) Variants -Sleeves -Suction |
| Transtibial Cuff | -Supracondylar cuff: -Leather strap anchoring on femoral epicondyles -May have waist belt attachment -Good for short RL, heavy thighs, and active patients -Easy adjustment except with visual or hand dysfunctions |
| AKA straps | -Grip above iliac crest |
| Thigh corset | -Lace up thigh w/ hinge to knee socket -Advantage: -Used on person w/ very sensitive skin -Increases the weight bearing and contact area -Disadvantage: -Heavier and may foster pistoning & pressure atrophy of the thigh -More difficult to don |
| Transtibial Brim Variant | -Supracondylar suspension: -Grips onto femoral epicondyles -May be above patella also -↑s medial/lateral stability -Good for shorter RL |
| Sleeves | -Grips soft tissue -Made of rubber silicon -Advantages: -Used for AKA/BKA -Grip is distributed over a greater area -Disadvantages: patient needs two strong hands and firm thigh musculature |
| Suction | -Works by pressure differences inside and outside of the socket -Internal pressure < less than external pressure -Atmospheric pressure causes the socket to remain on the thigh -One way air release valve on bottom of the socket |
| 3 types of suction | -Total -Partial -No |
| Total suction | -Very snug -Max control without auxiliary suspension -Most difficult donning/doffing |
| Partial suction | -Mod snugness -Sock needed -Additional suspension device needed |
| No suction | -Least snug -Multiple socks needed -Additional suspension device needed -No valve but a hole -Easy donning/doffing but control is sacrificed -Decreases sitting comfort |
| AKAs may also have... | -Knee unit and possibly... -Hip unit components |
| Knee unit: 4 possible components | -Axis system -Friction mechanism -Extension aid -Stabilizers -Personal bionics |
| 2 axis systems | -Single axis -Multiple axes |
| Friction mechanisms | -Changes speed of knee motion during various parts of swing phase according to walking speed -Controls knee motions and provides resistance to pendular motion |
| Friction mechanisms: 4 types | -Constant -Variable -Hydraulic/pneumatic -Microprocessor control |
| Constant friction | -Most popular -Same friction throughout motion -Easily adjusted -Usually prescribed for older adults |
| Variable friction | -Friction changes during swing phase -Early swing: high friction used to slow heel rise -Mid-swing: friction reduces to permit more natural swing -Late swing: friction increases to prevent impactful extension |
| Hydraulic or Pneumatic friction | -Oil/air medium -Adjusts resistance dynamically per walking speed -Prescribed for younger more active people -Heavier, more complicated, more expensive and more maintenance is required |
| Microprocessor control | -Can prevent stumbling -Computerized control -Beneficial when resistance is needed to change more frequently -Blue tooth capability settings -Computer Knee |
| Extension aid | -Assists knee extension during the later part of swing phase Keeps a constant rate of extension: -External -Simplest -Elastic webbing in front of the knee axis provides recoil -Internal: elastic strap or coiled spring inside the axis |
| Stabilizer | -Uncommon: most use hip motion or posterior alignment for stabilization -2 types: manual lock, friction brake |
| Stabilizer: Manual lock | -Simplest -Drop down loop over the hinge -Pin lodges on receptacle |
| Stabilizer: friction brake | -Brakes and slows knee flexion when weight bearing occurs with the knee in 0-20 degrees flexion |
| Personal bionics | -Power knee |
| Hip unit | -Provides flexion motions and extension aid to bias prosthesis toward neutral -Set below normal hip: -Relatively shorter thigh segment and longer leg segment -Won’t protrude when seated -Set anterior to normal hip to engage hip extensors |
| General maintenance: Foot and ankle assemblies | -Bumpers shoulder be replaced as needed -Keep dry -Keep sand and debris out of articulation |
| General maintenance: Socket & suspension | -Clean with damp cloth and mild soap, dry completely -Keep suction valve clear -Leather straps and corsets need saddle soap and conditioning |
| General maintenance: Knee and hip units | -Oil and tighten as needed to maintain alignment -Pneumatic and hydraulic units should be clear of debris, store upright with knee extended to remove air in the cylinder -Keep sand out |
| General maintenance: Exterior skeletons | -Clean, check for slitting -Avoid direct heat like radiators, heat vents, etc |
| Donning | -Show appropriate reference points and landmarks between the socket and RL -The pt needs to learn the correct feel of the prosthesis -The firmer the contact the more difficult it is to don (i.e. suction) |
| Donning sequence: 1) Liner/Socks | -Should not be wrinkled or rotated -Seam parallel to scar but not over it -Used to control volume...never more than 15 ply (layers) -Socks worn over a suction suspension or gel liner |
| Donning sequence: 2) Insert RL into socket | -Roll liner up before donning -Use powder or stockinet prn to pull RL into socket -May have to pump a suction socket |
| Donning sequence 3) | -Apply the suspension prn |
| Doffing | -Usually just a reversal of the donning sequence as the suction interface is usually peeled off after the socket is removed from the pin |
| Getting stuck | -Some patients may get stuck Slide his hand between the liner and the skin Break the suction and get out of the prosthesis |
Created by:
alovedaytn
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