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Transtibial Prosth.
Transtibial Prosthetics Presentation
| Question | Answer |
|---|---|
| Types of Prostheses | Post-Operative; Temporary; Definitive |
| Post-Operative Prostheses | Eliminates contracture potential; Reduces time to fitting of preparatory prosthesis; Restricted use on vascular/diabetic pt due to skin abrasion & inability to monitor residual limb |
| Preparatory Prosthesis | Basic- socket, pylon, foot; Allows early ambulation, promotes residual limb shrinkage; ~4-8 months Adjustable socket/interface Adjustable/interchangeable components; No cosmetic finish; 2nd socket req'd w/ extreme edema/rapid limb reduction |
| Definitive Prosthesis | Fit once limb stabilizes shape/size; Typically 3-5 yrs; Cosmetic & finished; Replace PRN |
| Endoskeletal Design | Modular; Anatomically shaped foam w/ soft cover; Pylon- aluminum, stainless steel, titanium, carbon; Adjustable, lightweight |
| Exoskeletal Design | Hard outer covering-laminated; Durable- pts in construction/farming; Not easily adjusted |
| Conventional Fabrication | Cast residual limb (- impression); Fill w/ plaster (+ mold) Add- tibial tub & crest, distal tib/fib, fib head, hams Remove- patella tendon, tib flare, popliteal area, calf mm Dx socket- static & dynamic alignments; Definitive socket laminated, foam s |
| Computer-Aided Fabrication (CAD/CAM) | Cast/scan residual limb; Converted to computer; Modified on computer; Sent to carver, + mold created out of foam; Same as conventional fabrication |
| Prosthetic Feet | Used on 90% pts |
| Foot Failure- Alignment | Socket & components not set in appropriate alignment; Forces improperly interacting with foot components & causing pre-mature wear |
| Foot Failure- Pt. Selection | Pt's activity level doesn't correspond to foot design; Pt's weight/activity has increased since initial fitting |
| Foot Failure- Proper Use | Pt abuses foot: walking w/o shoes; improper heel height; water damage; dust/dirt damage; lack of maintenance |
| Foot Failure- Shoe Selection | Pt has change heel height; Shoes old & in disrepair; Shoes don't provide adequate support for prosthetic foot |
| Choosing Appropriate Foot- Physical | Pt. height, weight & functional age; Knee disarticulation; trans-femoral; hip disarticulation; hemi-pelvectomy; bilateral; pediatric; adult; geriatric |
| Choosing Appropriate Foot- Functional- FL 0 | No ability or potential to ambulate or transfer |
| Choosing Appropriate Foot- Functional- FL 1 | Ability/potential to transfer or ambulate on level surfaces at fixed cadence |
| Choosing Appropriate Foot- Functional- FL 2 | Ability or potential for ambulation with ability to traverse low level barriers |
| Choosing Appropriate Foot- Functional- FL 3 | Ability/potential to ambulate with variable cadence |
| Choosing Appropriate Foot- Functional- FL 4 | Ability-potential to ambulate which exceeds basic ambulation skills |
| Choosing appropriate Foot- Financial | Initial investment; Maintenance; Replacement parts; Long-term replacement; Future insurance status |
| Choosing Appropriate Foot- Functional | Stability factor; Maintenance; Durability |
| Choosing Appropriate Foot- Patient Priorities | Function; Durability; Cosmetics; Comfort |
| Prosthetic Feet Functions | Joint stimulation; Shock absorption; Stable WB BoS; Muscle simulation; Cosmetically pleasing |
| Prosthetic Feet- Conventional | Solid-ankle cushioned heel (SACH); Stationary-attachment flexible endoskeletal (SAFE); Single-axis; Multi-axial; If not conventional, dynamic response/energy storing |
| SACH Foot | Solid Ankle Cushion Heel Simple design, low cost, lowest fxn; Cushion heel compresses on heel strike, rigid keel provides resistance during mid-stance; flexible forefoot provides rollover capabilities |
| SAFE Foot | Stationary Attachment Flexible Endoskeleton; Flexible internal keel permits tri-planar mvmt & easy "rollover"; Foot stiff & stable during stance |
| Single-Axis Foot | Provides PF & DF motion; Very stable at heel strike for AK amputees; Can adjust & exchange bumpers to modify foot response |
| Multi-Axis Foot | Multi-axial foot mvmt (PF/DF; Ev/Inv; IR/ER); Preferred for uneven terrain; Absorbs gait torque to reduce shearing forces on residual limb |
| Energy Storing/Dynamic Response | Internal keel structure "absorbs" energy during mid-stance & temrinal stance; "Releases" energy at pre-swing (toe off) to provide smoother/more energy efficient gait; Extremely lightweight & durable |
| Special Activity Foot | Accomodates unique & specific demands of athlete & sport; Typically customized foot can only be used for 1 specific activity or sport |
| Foot Enhancements- Vertical Shock Absorber | Built into foot or attached as separate component; Reduces impact forces during stance/heel strike; Reduces shear within socket; Improves rotational forces at heel strike |
| Foot Enhancements- Rotational Torque Absorber | Built into foot or attached separately; Absorbs gait torque to reduce shearing forces on residual limb; Provides rotation mobility for standing & twisting mvmts |
| Specialty Foot Considerations- Heel height adjustable foot | Pt can make adjustment to foot to accommodate various shoe heel heights while maintaining uniform distance from heel to the knee center |
| Socket Design | Patellar Tendon Bearing (PTB) Total Surface Bearing (TSB) |
| PTB- Areas of WB | Patellar tendon, medial tibial flare, fibular midshaft |
| PTB- Areas of Relief | Lateral tibia, head & distal end of fibula, tibial crest, distal end of tibia |
| PTB- Functions | Medial/lateral control rotation & provide ML stability; Posterior wall applies anterior force to PTB |
| Total Surface Bearing | Same areas of relief & WB as PTB, just not as aggressive; Idea is total global reduction; Distribute weight & pressure equally throughout limb |
| Liners | No liner; Pelite liner (custom); OTS gel liner; Custom gel liner |
| No liner | Hard socket- no liner, just sock or soft interface |
| Advantages & Disadvantages to No Liner | A: Less bulk, easier cleaning, fewer perspiration issues D: More difficult to fit, less comfortable |
| Advantages & Disadvantages to a Liner | A: Total contact= decreased edema; Modifications to liner D: Deterioration over time; Sanitation due to perspiration absorption; Increased weight; Difficulty donning |
| Pelite Liner | Commonly used with PTB socket; Distal end pad- plastazote or formed form |
| OTS Gel Liner | Even pressure distribution; Minimal shear forces; High shock absorption; Most limbs; Various thicknesses |
| Custom liner | Used with "problem" pts; Otto Bock TEC liner; Can vary in thickness; Increased cost with better fit |
| Types of Suspension | Supracondylar cuff; Supracondylar system; Supracondylar/suprapatellar system; Thigh corset; Waist belt; Suspension sleeve; Locking liner |
| Supracondylar Cuff | Cuff suspended above femoral condyles & proximal patella; Resists hyperextension |
| Supracondylar System | Wedge suspension on medial wall; Removable for donning & doffing; Wedge holds over femoral condyle |
| Supracondylar/Suprapatellar System (PTB SC/SP) | High walls encompass femoral condyles & patella; Used for extremely short limbs or ML instability |
| Thigh Corset | Leather lacer or laminate around thigh; Provides max ML stability; Controls hyperextension (check strap); Atrophies thigh |
| Waist Belt | Used most often in temporary; 2" webbing around waist attaches to supracondylar cuff; Inverted "Y" design |
| Suspension Sleeve | Gel liner next to skin; Sleeve over prosthesis pulled up over thigh sealing against skin; Creates sealed chamber & suspends leg |
| Locking Liner | Gel liner with locking mechanism; Pin attached to bottom; Slide into socket-locks; Press button to release |
| Vacuum System | Lower- mechanical pump out; expulsion valve; negative vacuum; Upper- higher vacuum with electric pump; sucks air out |
| Exam/Checkout Procedure | Static (standing); Static (sitting); Dynamic (walking) |
| Standing Exam | Foot flat on floor (with shoe); Correct height; No leaning pylon |
| Sitting Exam | Adequate hamstring relief; Liner pulled up; When donning- invert liner completely to avoid any excess air |
| Walking Exam | Gait deviations noted; Pistoning minimal; No leaning pylon |
| Sock Wear | As limb shrinks inside socket- replaces lost volume to maintain total contact; Different thickness "ply"; Add cushioning; Reduce friction |
| Liner Care | Wipe, wash, rinse well daily; Allow to dry thoroughly; Don't invert; Inspect for cracks |
| Socket Care | Wash with soap & water; Allow to dry thoroughly |
Created by:
1190550002
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