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Prosthetics&Orthotics > L6: Stairs, Transfers, then Peds+Special Considerations > Flashcards

L6: Stairs, Transfers, then Peds+Special Considerations Flashcards

1
Q

Stair Negotiation:

TTAs

What is the most IMPORTANT COMPONENT

A

ANKLE

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2
Q

Stair Negotiation: TTAs

LTG:

A
  • Efficient, reciprocal pattern (AD, handrail)
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3
Q

Stair Negotiation: TTAs

What should the process of stair negotiation look like/Most important component

A
  • Ankle is most important component
    • When Descending→ foot close to edge OR over edge== facilitates knee flexion
      • PT can help control knee flex
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4
Q

Stair Negotiation: TTAs

IF Non-Reciprocal

Pattern ?

A

UP w/ the GOOD→ “intact limb”

DOWN w/ the BAD→ “prosth side”

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5
Q

Stair Negotiation: TTAs

If anxious or do NOT have knee flex ROM….

A

Teach to go up/down sideways holding handrail

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6
Q

Stair Negotiation: TTAs

If not SAFE….

A

Doff prosth and either use ADs: Crutches, cane, 2 handrails (B/L UE A), or bump up

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7
Q

Stair Negotiation: TFAs

Most important component?

A

KNEE

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8
Q

Most important component of stair negotiation for TTAs

A

Ankle

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9
Q

Most important component in stair negotiation for TFAs:

A

Knee

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10
Q

Stair Negotiation: TFAs

Pattern taught depends almost ENTIRELY on what?

2:

A

Knee component

Control of knee

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11
Q

Stair Negotiation: TFAs

Pattern taught depends on knee component and control of knee

Microprocessor knees/some hydraulic and pneumatic knees

A

Efficient, reciprocal pattern is REALISTIC LTG*

Do NOT UNDERtrain them!!!

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12
Q

Stair Negotiation: TFAs

Pattern taught depends on knee component and control of knee

Wt. Activated or Safety (total knees) dependent on:

A

Length of RL

Strength

Balance, cognition, etc.

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13
Q

Stair Negotiation: TFAs

Pattern taught depends on knee component and control of knee

W/ Single-axis OR low-resistance knees

A

Typ lock knee and teach non-reciprocal or sideways

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14
Q

Stair Negotiation: TFAs

Stairs

More tidbits…

A
  • When descending foot close to edge OR over edge to facilitate knee flex: may cause anxiety
    • Two hands on rails, shorter step in //bars, step overs
    • PT can help control knee flex
    • Teach pt to “ride” C-legs ecc. resistance
      • work WITH it
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15
Q

Stair Negotiation: TFAs

Alternatives to Reciprocal

A
  • If non recip→ Usually UP w/ GOOD, DOWN w/ BAD
    • Good→ intact limb
    • Bad→ prosth side
  • If anxious or do not have knee flex ROM→ up/down sideways holding rail
  • If not SAFE→ doff prosth and use ADs, or bump up
    • PROBLEM: leaves pt w/out prosth.
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16
Q

Stair negotiation

A

See video slide 6****

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17
Q

Ramp Negotiation:

TTAs w/ SACH or SAFE feet…

Explain

A

Difficulties w/ standard incline grades

Accommodate @ knee, hip, trunk

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18
Q

Ramp Negotiation:

TTAs w/ Mobile feet

i.e. Single Axis w/ large ROM, Multi-axis, Dynamic Response, Microprocessor

A

Min. diffs w/ ascend/descend ramps

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19
Q

Ramp Negotiation:

Describe step length

A
  • Typ Longer step w/ prosth.
  • Shorter step w/ uninvolved due to lack of DF
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20
Q

Ramp Negotiation:

IND/safety w/ TFAs largely dependent on ______ and ________

A

Knee and Ankle component

*NOTE: newer gen knees/feet have MIN. diffs w/ ramps

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21
Q

Ramp Negotiation:

Little knee control and immobile ankle/foot complexes will NOT have ability to amb w/out obv compensations which may also compromise safety

What should you do?

A

Teach sideways w/ prosth side ALWAYS low

PT guards/supervises from BELOW

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22
Q

Ramp negotiation

Where does PT guard?

A

Guard from Below

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23
Q

C-leg: Downhill/Ecc control

A

Video slide 9

24
Q

Sit ←→ Stand Transfers

How can you OVERPOWER or facilitate use of the Prosth side?

A

Reach and stand

Elevate UNinvolved side

Prosth. LE slightly posterior

25
Q

Sit ←→ Stand Transfers

Regardless of lvl of amputee:

Goal?

A

Become IND w/ EQUAL LE use

26
Q

Sit ←→ Stand Transfers

TFAs should be able to flex hip to 90degs

T/F???

A

TRUE!!!!!!!!!!

27
Q

Sit ←→ Stand Transfers

Technique taught depends on:

4:

A
  1. Strength of hip/knee EXTs
  2. Length of RL
  3. Control of knee
  4. Ht of surface
28
Q

Falling and Floor to Sit Transfers

What is KEY?

A

PREVENTION!!!

29
Q

Falling and Floor to Sit Transfers

Teach HOW to fall:

A
  • Whenever possible→ Fall forward OR to in-tact side
  • Once on ground advise them NOT to try and stand right away
    • Get bearings and ensure no other injuries
    • Remove prosth.
    • Bump or crawl to LOW surface and use UEs to get to sit
    • Wait for help
30
Q

Falling and Floor to Sit Transfers

To stand back up:

A
  • Place sound leg directly under trunk and use UEs either on that LE OR on chair/other surf.
    • Reqs strength/balance
31
Q

Special considerations: Children

Some stats

A
  • 58.5% congenital deforms are UEs
  • Fitting timetable for UE usually @ 6mos
    • 8 mos for LEs
  • Gradeschool children req new prosth every 12-18mos
  • Teens every 18-24mos
32
Q

Special Considerations: Children

Fittings

A
  • For LE infants→ SACH foot initially
    • as child becomes more active, dynamic resp feet prescribed
33
Q

Special Considerations: Children

Children w/ TFA:

A

Whenever possible fit w/ friction control knee (hydraulic) w/ an extension assist to assimilate gait pattern of child

34
Q

Special Considerations: Children

A
  • Diff w/ fitting as rapid leg changes and meeting functional goals during growth/development
  • More agile w/ stronger skin and less skin breakdown vs adults
  • Considerable walking proficiency earlier in rehab
  • Adaptive neuro. mapping from birth accommodates for loss of limbs
35
Q

Special Considerations: Children

Proximal Focal Femoral Deficiency (PFFD)

What is this?

A

Femur and Pelvis malformed @ birth

*NOTE: Depending on length of residuum→ may be approached as hip disartic OR TFA→ If foot and ankle present, may be Van Ness candidate

36
Q

Special Considerations: Children

Van Ness Procedure aka

A

Longitudinal deficiency of femur

*Turn tibia posteriorly

37
Q

Special Considerations: Children

Van Ness Procedure (Rotationplasty)

Explain it

A
  • Foot and ankle rotated and becomes the knee
    • DF becomes Knee Flexion, PF→ knee ext
    • =better control of prosth.
  • usually bw 5-12yo

See video slide 17***

38
Q

Van Ness aka Rotationplasty Pics

A

see pics

39
Q

Special Considerations: B/L amps

Result from

A

Trauma→ MVA, electrocution, land mines, bombs

40
Q

Special Considerations: B/L Amps

Critical to what?

A

Critical to preserve @ least one anatomical knee joint which sig incs chances for practical amb.

-Schuling et al. 1994

41
Q

Special Considerations: B/L Amps

These B/L amps usually do very well w/ prosth training

A

B/L TTA

*less energy cost to walk vs U/L TFA

42
Q

Special Considerations: B/L Amps

Functional Capacity

A
  • Incd energy expend.→ need lt. wt. prosth design
  • Decd sensory feedback→ decd balance
  • May need 2 canes/LFST to inc BOS and push-off
43
Q

Special Considerations: B/L Amps

B/L TTA

A
  • Usually same ankle/foot comps both sides
  • SACH foot offers most predictable standing balance
  • Usually single-axis or multi-axis feet chosen bc of balance
    • Consistency of ea step is crucial bc no “good foot”
44
Q

Special Considerations: B/L Amps

B/L TFA

A
  • Posture/Balance sig. compromised
    • wider BOS during stand/gait due to PROX. fit
  • usually solid ankle used
  • MANY B/L TFA use AD
  • Many B/L TFA choose WC as primary source of mobility
45
Q

Special Considerations: B/L Amps

B/L TFA

A
  • Incd WB forces thru both LEs→ Reqs soft flexible IRC containment socket to reduce skin breakdown
46
Q

Special Considerations: B/L Amps

B/L TFA

“Stubbies”

A

Sockets attached to specialized rocker platforms early in gait training

  • LESS energy and balance reqs
  • Gradual lengthening of prosth. until norm ht is managed
47
Q

B/L amps

A

TTA on one side, TFA on other

48
Q

Special Considerations: Hip Disarticulation/Hemipelvectomy→ half pelvis removed

How many jts to control now?

A

Three

49
Q

Special Considerations: Hip Disarticulation/Hemipelvectomy→ half pelvis removed

3 joints to control: what is crucial?

A

Trunk/Core strength

50
Q

Special Considerations: Hip Disarticulation/Hemipelvectomy→ half pelvis removed

Explain prosth joints used

A
  • Usually solid ankle designs→ more joints to control, want stable ankle
  • Typ hydraulic and pneumatic knees for more active pts
  • Microprocessor knees used more freq now
51
Q

Special Considerations: Hip Disarticulation/Hemipelvectomy→ half pelvis removed

Talk about hip

A
  • Usually free motion hip w/ flexible carbon fiber thigh “strut” that functions as leaf spring
    • improves limb shortening for Sw
  • ***SEE VIDEO IN CANVAS!!!!!!!
52
Q

Special Considerations: Hip Disarticulation/Hemipelvectomy→ half pelvis removed

A

SEE PICS

53
Q

Special Considerations: Hip Disarticulation/Hemipelvectomy→ half pelvis removed

STATS

A
  • 200% more effort to walk vs unimpaired walking
  • High prosth. rejection rates bc gait is slow and energy consuming
    • usually resort to single limb gait w/ AD to inc speed/dec effort

*Also need 2nd person just to Don

54
Q

REVIEW VIDEOS!!!!

A

SEE SLIDE 32

55
Q

GOAL WRITING FOR AMPUTEES

A

SEE SLIDE 33 TO PRACTICE

*remember function AND go back in lectures to understand what STGs and LTGs should Focus On!!!!!

Prosthetics&Orthotics (19 decks)

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