Chapter 04 Amputations and Prosthetics Flashcards Preview

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Flashcards in Chapter 04 Amputations and Prosthetics Deck (56):
1

Amputation due to _________ disease accounts for 54% of cases, and of these, two-thirds have a diagnosis of _________. Trauma accounts for 45% of cases and cancer for the remaining less than 2%.

Amputation due to dysvascular disease accounts for 54% of cases, and of these, two-thirds have a diagnosis of DM. Trauma accounts for 45% of cases and cancer for the remaining less than 2%.

2

The Chopart is _______; the Lisfranc is _______.

The Chopart is shorter; the Lisfranc is longer.

3

Transhumeral – _______ appendage with retention of the _______ tuber-osity. Generally, the longer the better (up to 90% of normal length).

Transhumeral – Cylindrical appendage with retention of the deltoid tuber-osity. Generally, the longer the better (up to 90% of normal length).

4

Transradial – Ideal shape follows the contours of the natural limb. Longer appendages provide better _______ arms and more _______/_______ and are optimal for _______-powered prostheses and heavy labor. Retention of the _______ improves elbow flexion. Medium length limbs are optimal for externally powered prostheses.

Transradial – Ideal shape follows the contours of the natural limb. Longer appendages provide better lever arms and more pronation/supination and are optimal for body-powered prostheses and heavy labor. Retention of the brachioradialis improves elbow flexion. Medium length limbs are optimal for externally powered prostheses.

5

Transfemoral – Ideal shape is _______. Longer residual limbs improve seating balance and tolerance. For shorter limbs, maintaining the _______ _______ and its attachment to the hip _______ is key.

Transfemoral – Ideal shape is conical. Longer residual limbs improve seating balance and tolerance. For shorter limbs, maintaining the greater trochanter and its attachment to the hip abductors is key.

6

Transtibial – Ideal shape and length is a _______ appendage about one-third the original tibial length, with retention of the patellar tendon attachment to the _______ _______. The _______ should be shorter than the _______. In vascular disease, longer limbs may not have adequate circulatory supply and fitting of the below-knee socket may be problematic. The ideal length recommended from medial tibial plateau to bony end is 5″ to 7″.

Transtibial – Ideal shape and length is a cylindrical appendage about one-third the original tibial length, with retention of the patellar tendon attachment to the tibial tuberosity. The fibula should be shorter than the tibia. In vascular disease, longer limbs may not have adequate circulatory supply and fitting of the below-knee socket may be problematic. The ideal length recommended from medial tibial plateau to bony end is 5″ to 7″.

7

Post-Amputation Pre-Prosthetic Wound Care – Keep limb clean and protected and debride any nonviable tissue.
Edema Control
• Elastic wraps: Most commonly _________. Must use figure-of-8 elastic wrapping, which should begin immediately after surgery and should ideally be rewrapped qid. May be time consuming.
• Elastic socks: Alternative to wraps. Not expensive and easy to apply.
• _________ dressings: Protective. Allow for weight bearing to desensitize the limb. Examples include the immediate postoperative-fitting prosthesis, which is not removable and therefore inhibits ability to check and desensitize the skin. The removable rigid dressing is custom made and allows for wound inspection and desensitization.
_______ _______ massage should be instituted as soon as tolerated to help prevent adherence of the scar to the underlying soft tissues and bone. Once the sutures are removed, the massage can be performed more aggressively.

Post-Amputation Pre-Prosthetic Wound Care – Keep limb clean and protected and debride any nonviable tissue.
Edema Control
• Elastic wraps: Most commonly Ace bandages. Must use figure-of-8 elastic wrapping, which should begin immediately after surgery and should ideally be rewrapped qid. May be time consuming.
• Elastic socks: Alternative to wraps. Not expensive and easy to apply.
• Rigid dressings: Protective. Allow for weight bearing to desensitize the limb. Examples include the immediate postoperative-fitting prosthesis, which is not removable and therefore inhibits ability to check and desensitize the skin. The removable rigid dressing is custom made and allows for wound inspection and desensitization.
Scar mobilization massage should be instituted as soon as tolerated to help prevent adherence of the scar to the underlying soft tissues and bone. Once the sutures are removed, the massage can be performed more aggressively.

8

Anticontracture Management – Due to muscle imbalance. AKA commonly develop ______, hip ______, and hip ______ rotation contractures. In addition, BKA develop KF contractures. Prevent with a firm mattress, prone lying 15 minute tid, and promoting knee extension while resting. A posterior splint to maintain knee extension can be considered for patients at higher risk.

Anticontracture Management – Due to muscle imbalance. AKA commonly develop HF, hip abduction, and hip external rotation contractures. In addition, BKA develop KF contractures. Prevent with a firm mattress, prone lying 15 minute tid, and promoting knee extension while resting. A posterior splint to maintain knee extension can be considered for patients at higher risk.

9

Preprosthetic and Prosthetic Training – Hip AROM and strengthening exercises are key. A good test to determine cardiovascular tolerance for prosthesis use is ambulation with a ______ (without a prosthesis). Prosthetic gait training should begin with ______ ______ and progress to walkers or canes. Crutches should be avoided since they promote poor gait patterns. The definitive prosthesis is usually created at ______ to ______ months.

Preprosthetic and Prosthetic Training – Hip AROM and strengthening exercises are key. A good test to determine cardiovascular tolerance for prosthesis use is ambulation with a walker (without a prosthesis). Prosthetic gait training should begin with parallel bars and progress to walkers or canes. Crutches should be avoided since they promote poor gait patterns. The definitive prosthesis is usually created at 3 to 6 months.

10

TRANSTIBIAL PROSTHETICS: Socket Designs: The socket connects the residual limb to the rest of the prosthesis and plays an important role in the transfer of body weight to the ground (Fig. 4-4).
The PTB socket is an old term for the ______ ______ ______. The ______ tendon actually only bears a moderate load. Weight is distributed over many areas (see “pressure-tolerant areas” in Fig. 4-5), but not over the bony prominences.
For any socket, soft inserts made of polyethylene foam or silicone gel provide extra protection, e.g., for cases of PVD or extensive scarring. The inserts, however, reduce the intimacy of contact between the limb and prosthesis, which is important for ______. A soft foam distal end discourages ______ ______ formation.

TRANSTIBIAL PROSTHETICS: Socket Designs: The socket connects the residual limb to the rest of the prosthesis and plays an important role in the transfer of body weight to the ground (Fig. 4-4).
The PTB socket is an old term for the total contact socket. The patellar tendon actually only bears a moderate load. Weight is distributed over many areas (see “pressure-tolerant areas” in Fig. 4-5), but not over the bony prominences.
For any socket, soft inserts made of polyethylene foam or silicone gel provide extra protection, e.g., for cases of PVD or extensive scarring. The inserts, however, reduce the intimacy of contact between the limb and prosthesis, which is important for proprioception. A soft foam distal end discourages verrucous hyperplasia formation.

11

TRANSTIBIAL PROSTHETICS: Selected Suspension Options
 
Differential Pressure (Silicone Suction with Shuttle Lock) – A flexible, molded silicone liner is rolled directly onto the residual limb and secured to the socket with a pin. This provides optimal suspension and proprioception, but requires stable limb volumes and good hand dexterity for donning/doffing.
Anatomic – A _______ _______ is an extension of the socket over the femoral epicondyles. This design is easy to don/doff, provides mediolateral knee stability, and is useful for _______ limb lengths.
The supracondylar cuff clips on above the epicondyles and is a common suspension option. This design is not indicated in patients with very short residual limbs or with mediolateral knee instability. A supracondylar cuff with fork strap and waist belt suspension provides additional stability for very active patients, e.g., manual laborers.
Sleeve – An elastic sleeve can serve as a primary or secondary suspension via longitudinal tension and negative pressure during swing phase. It can provide additional security for short residual limbs, when medio-lateral knee stability is questionable, or when hyperextension control is required (Fig. 4-6).

TRANSTIBIAL PROSTHETICS: Selected Suspension Options
 
Differential Pressure (Silicone Suction with Shuttle Lock) – A flexible, molded silicone liner is rolled directly onto the residual limb and secured to the socket with a pin. This provides optimal suspension and proprioception, but requires stable limb volumes and good hand dexterity for donning/doffing.
Anatomic – A brim suspension is an extension of the socket over the femoral epicondyles. This design is easy to don/doff, provides mediolateral knee stability, and is useful for short limb lengths.
The supracondylar cuff clips on above the epicondyles and is a common suspension option. This design is not indicated in patients with very short residual limbs or with mediolateral knee instability. A supracondylar cuff with fork strap and waist belt suspension provides additional stability for very active patients, e.g., manual laborers.
Sleeve – An elastic sleeve can serve as a primary or secondary suspension via longitudinal tension and negative pressure during swing phase. It can provide additional security for short residual limbs, when medio-lateral knee stability is questionable, or when hyperextension control is required (Fig. 4-6).

12

Solid Ankle Cushioned Heel Foot – SACH feet are light, durable, inexpensive, and stable. The _____ heel simulates _____ during heel strike (Fig. 4-7A).

Solid Ankle Cushioned Heel Foot – SACH feet are light, durable, inexpensive, and stable. The soft heel simulates PF during heel strike (Fig. 4-7A).

13

Single-Axis Foot – These feet are heavier but less _____ than the SACH feet. They are most commonly used for _____ amputees, i.e., when knee _____ is desired (a quick foot flat improves knee stability). Only _____ axis movement is allowed.

Single-Axis Foot – These feet are heavier but less durable than the SACH feet. They are most commonly used for TF amputees, i.e., when knee stability is desired (a quick foot flat improves knee stability). Only sagittal axis movement is allowed.

14

Multiaxis Foot (Greissinger, Endolite Multiflex, SAFE II, TruStep) – The multiaxis foot allows _____/_____, inversion/eversion, and rotation, which improve balance and coordination. It provides good shock absorption and is good for uneven ground, but is heavy, costly, and needs relatively frequent adjustments or repairs.

Multiaxis Foot (Greissinger, Endolite Multiflex, SAFE II, TruStep) – The multiaxis foot allows PF/DF, inversion/eversion, and rotation, which improve balance and coordination. It provides good shock absorption and is good for uneven ground, but is heavy, costly, and needs relatively frequent adjustments or repairs.

15

DER Foot (Seattle Light, Carbon Copy II, Quantum Foot, Flex-Foot, SpringLite) – These feet were formerly called “energy-storing feet,” but they have not demonstrated a reduction in the energy cost or rate of energy expenditure during level walking, compared with the SACH foot.3 They may, however, be more efficient than other feet at _____ speeds. _____ amputees benefit from the light weight of these feet (Fig. 4-7B).

DER Foot (Seattle Light, Carbon Copy II, Quantum Foot, Flex-Foot, SpringLite) – These feet were formerly called “energy-storing feet,” but they have not demonstrated a reduction in the energy cost or rate of energy expenditure during level walking, compared with the SACH foot.3 They may, however, be more efficient than other feet at higher speeds. Geriatric amputees benefit from the light weight of these feet (Fig. 4-7B).

16

Traditional Socket Designs
 
TF sockets are often fitted in slight (5°) _______ and _______ to stretch the hip _______ and _______ and give them a mechanical advantage.

Traditional Socket Designs
 
TF sockets are often fitted in slight (5°) flexion and adduction to stretch the hip extensors and abductors and give them a mechanical advantage.

17

QUADRILATERAL DESIGN
This ischial–gluteal weight–bearing, narrow _______ design was originally designed by Inman and Eberhart at UC Berkeley in the 1950s. It has four sides and four corners. It is easy to make and fit but less stable for _______ residual limbs and less comfortable when sitting than the ischial containment design (Fig. 4-8A).

QUADRILATERAL DESIGN
This ischial–gluteal weight–bearing, narrow anteroposterior design was originally designed by Inman and Eberhart at UC Berkeley in the 1950s. It has four sides and four corners. It is easy to make and fit but less stable for shorter residual limbs and less comfortable when sitting than the ischial containment design (Fig. 4-8A).

18

ISCHIAL CONTAINMENT DESIGN
A “bony lock” incorporates the ischial _______, _______ _______, and greater trochanter. The posterior rim provides ischial–gluteal weight bearing and is contoured for the ischial tuberosity and gluteal muscles. These features improve stability, particularly for shorter residual limbs. The narrow medio-lateral design also provides a more efficient energy cost of ambulation than the narrow anteroposterior design at high _______ (Fig. 4-8B).

ISCHIAL CONTAINMENT DESIGN
A “bony lock” incorporates the ischial tuberosity, pubic ramus, and greater trochanter. The posterior rim provides ischial–gluteal weight bearing and is contoured for the ischial tuberosity and gluteal muscles. These features improve stability, particularly for shorter residual limbs. The narrow medio-lateral design also provides a more efficient energy cost of ambulation than the narrow anteroposterior design at high speeds (Fig. 4-8B).

19

Suction – ________ socket pressure maintains prosthetic attachment during swing phase. The ________ ________ is pulled through a one-way valve hole. Its use is indicated in active amputees with well-shaped, nonfluctuating residual limbs.

Suction – Subatmospheric socket pressure maintains prosthetic attachment during swing phase. The sock bandage is pulled through a one-way valve hole. Its use is indicated in active amputees with well-shaped, nonfluctuating residual limbs.

20

Silesian Belt or Bandage – A belt that attaches from the socket at the greater trochanter and wraps around the ________ ________ ________ (Fig. 4-9A).

Silesian Belt or Bandage – A belt that attaches from the socket at the greater trochanter and wraps around the opposite iliac crest (Fig. 4-9A).

21

Total Elastic Suspension (Belt) – Wraps around the proximal prosthesis and waist, enhancing ________ control. It retains body heat and has limited durability (Fig. 4-9B).

Total Elastic Suspension (Belt) – Wraps around the proximal prosthesis and waist, enhancing rotational control. It retains body heat and has limited durability (Fig. 4-9B).

22

Pelvic Band and Belt Suspension – A rigid belt is connected to a metal hip joint on the lateral side of the socket. It is indicated for improving rotational and mediolateral pelvic stability in ________ patients with significant redundant tissue or weak abductors with short or poorly shaped amputations. It is heavy and bulky and tends to interfere with ________ (Fig. 4-9C).

Pelvic Band and Belt Suspension – A rigid belt is connected to a metal hip joint on the lateral side of the socket. It is indicated for improving rotational and mediolateral pelvic stability in obese patients with significant redundant tissue or weak abductors with short or poorly shaped amputations. It is heavy and bulky and tends to interfere with sitting (Fig. 4-9C).

23

Single-Axis or Constant friction – This knee is durable and inexpensive, but the _______ is fixed, or else the swing phase will be _______. Stability is poor. It is indicated for level surfaces (Fig. 4-10).

Single-Axis or Constant friction – This knee is durable and inexpensive, but the cadence is fixed, or else the swing phase will be asymmetric. Stability is poor. It is indicated for level surfaces (Fig. 4-10).

24

Stance Phase Control or Safety Knee Joint – The stance phase control knee can control KF during weight bearing, which provides stability during stance phase. It is a common initial prosthesis used in geriatrics, general debility, and poor hip control. It allows ambulation on _______ surfaces. A delayed swing phase is noted, as full unloading is needed to flex the knee.

Stance Phase Control or Safety Knee Joint – The stance phase control knee can control KF during weight bearing, which provides stability during stance phase. It is a common initial prosthesis used in geriatrics, general debility, and poor hip control. It allows ambulation on uneven surfaces. A delayed swing phase is noted, as full unloading is needed to flex the knee.

25

Polycentric – This typically has a _______-bar linkage design and a shifting instantaneous center of rotation that remains behind the GRF, providing increased stability during _______ phase. The center of rotation moves proximally and posteriorly to the anatomic knees. Cosmesis is excellent, especially during sitting, but polycentrics are heavy, costly, and require high maintenance. It is indicated for knee _______ and _______ TF amputees (Fig. 4-10B).

Polycentric – This typically has a 4-bar linkage design and a shifting instantaneous center of rotation that remains behind the GRF, providing increased stability during stance phase. The center of rotation moves proximally and posteriorly to the anatomic knees. Cosmesis is excellent, especially during sitting, but polycentrics are heavy, costly, and require high maintenance. It is indicated for knee disarticulations and short TF amputees (Fig. 4-10B).

26

Fluid Controlled (Pneumatic or Oil) – The design uses a piston in a fluid-filled cylinder, which provides automatic swing phase control at _______ cadences. It provides a smooth and natural gait, but is heavy, costly, and requires high maintenance.

Fluid Controlled (Pneumatic or Oil) – The design uses a piston in a fluid-filled cylinder, which provides automatic swing phase control at variable cadences. It provides a smooth and natural gait, but is heavy, costly, and requires high maintenance.

27

Manual Locking or Fixed Lock – The knee of last resort, this design provides the ultimate in stability. The gait, however, is awkward and _______ consuming.

Manual Locking or Fixed Lock – The knee of last resort, this design provides the ultimate in stability. The gait, however, is awkward and energy consuming.

28

Microprocessor-Controlled Hydraulic Knee Joint – The C-Leg is composed of a complex system of sensors that records stresses every 0.02 seconds, measuring both the ankle movement and the angle and angular velocity of the knee joint. With this information, the joint continuously recognizes which walking phase the wearer is currently in and adjusts automatically. There is a high level of resistance in stance phase, allowing for the ability to bear weight on the prosthesis during flexion, yielding low-energy expenditure and improved gait _______ on stairs, inclines, and uneven terrain. Disadvantages include having to recharge the battery every night, increased cost, and high maintenance.

Microprocessor-Controlled Hydraulic Knee Joint – The C-Leg is composed of a complex system of sensors that records stresses every 0.02 seconds, measuring both the ankle movement and the angle and angular velocity of the knee joint. With this information, the joint continuously recognizes which walking phase the wearer is currently in and adjusts automatically. There is a high level of resistance in stance phase, allowing for the ability to bear weight on the prosthesis during flexion, yielding low-energy expenditure and improved gait symmetry on stairs, inclines, and uneven terrain. Disadvantages include having to recharge the battery every night, increased cost, and high maintenance.

29

Pain – Multiple causes
Prosthetic use: ______ irritation, prosthetic fit.

Pain – Multiple causes
Prosthetic use: Skin irritation, prosthetic fit.

30

Phantom Pain – Phantom limb sensation, phantom limb pain, and generalized limb pain are maintained by ______, ______, and ______ dysfunction.4
Phantom limb pain can be described as sharp, burning, stabbing, tingling, shooting, electric, or cramping.5 Treatment options include desensitization (e.g., massaging and tapping), neuropathic pain agents, topical anesthetics, modalities (e.g., TENS units), and injections into neuromas.

Phantom Pain – Phantom limb sensation, phantom limb pain, and generalized limb pain are maintained by afferent, central, and efferent dysfunction.4
Phantom limb pain can be described as sharp, burning, stabbing, tingling, shooting, electric, or cramping.5 Treatment options include desensitization (e.g., massaging and tapping), neuropathic pain agents, topical anesthetics, modalities (e.g., TENS units), and injections into neuromas.

31

Choke Syndrome – Distal limb edema and painful ______ ______ may develop due to proximal limb pressure and a lack of total contact with the prosthesis. An underlying vascular disorder is usually present. Treatment involves adding a distal pad to the socket, correcting the suspension, removing proximal pressure, and/or refitting the socket.

Choke Syndrome – Distal limb edema and painful verrucous hyperplasia may develop due to proximal limb pressure and a lack of total contact with the prosthesis. An underlying vascular disorder is usually present. Treatment involves adding a distal pad to the socket, correcting the suspension, removing proximal pressure, and/or refitting the socket.

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Causes of Stance Phase Problems
Excessive Trunk Extension/Lumbar Lordosis During Stance Phase – A poorly shaped _______ wall may cause patients to forwardly rotate their pelvis for pressure relief, with compensatory trunk extension. Other causes include insufficient initial _______ built into socket, HF _______, and weak hip extensors.
Causes of Stance Phase Problems
Excessive Trunk Extension/Lumbar Lordosis During Stance Phase – A poorly shaped posterior wall may cause patients to forwardly rotate their pelvis for pressure relief, with compensatory trunk extension. Other causes include insufficient initial flexion built into socket, HF contracture, and weak hip extensors.

Causes of Stance Phase Problems
Foot Slap – Foot slap may be noted with a TF locked-knee prosthesis if the foot is _______ placed or if socket _______ is excessive.
Causes of Stance Phase Problems
Foot Slap – Foot slap may be noted with a TF locked-knee prosthesis if the foot is posteriorly placed or if socket flexion is excessive.

33

Causes of Stance Phase Problems
Knee Buckling/Instability – Causes include knee axis too _______, insufficient PF, failure to limit DF, weak hip extensors, hard heel, large HF contracture, and posteriorly placed foot. Stability is achieved with a plan-tarflexed foot, a soft heel (i.e., SACH), or a more anteriorly placed foot.

Causes of Stance Phase Problems
Knee Buckling/Instability – Causes include knee axis too anterior, insufficient PF, failure to limit DF, weak hip extensors, hard heel, large HF contracture, and posteriorly placed foot. Stability is achieved with a plan-tarflexed foot, a soft heel (i.e., SACH), or a more anteriorly placed foot.

34

Causes of Stance Phase Problems
Lateral Bending – Causes include a prosthesis that is too _______, insufficient lateral wall, abducted socket, abduction contracture, and poor amputee balance.

Causes of Stance Phase Problems
Lateral Bending – Causes include a prosthesis that is too short, insufficient lateral wall, abducted socket, abduction contracture, and poor amputee balance.

35

Causes of Stance Phase Problems
Vaulting – Vaulting of the nonprosthetic limb may be due to a prosthesis that is too _______, too much knee _______, or poor suspension.

Causes of Stance Phase Problems
Vaulting – Vaulting of the nonprosthetic limb may be due to a prosthesis that is too long, too much knee friction, or poor suspension.

36

Causes of Stance Phase Problems
Whip – A whip is an abrupt rotation of the heel occurring at the end of stance phase as the knee of a TF prosthesis is flexed to begin swing. If the heel moves medially, it is a _______ whip; if laterally, a _______ whip. Causes include improper rotatory alignment of the knee axis, a knee axis not parallel to the floor, or flabby muscles about the femur with the prosthesis rotating freely within the underlying soft tissue.

Causes of Stance Phase Problems
Whip – A whip is an abrupt rotation of the heel occurring at the end of stance phase as the knee of a TF prosthesis is flexed to begin swing. If the heel moves medially, it is a medial whip; if laterally, a lateral whip. Causes include improper rotatory alignment of the knee axis, a knee axis not parallel to the floor, or flabby muscles about the femur with the prosthesis rotating freely within the underlying soft tissue.

37

Causes of Swing Phase Problems
Abducted Gait – Causes include a prosthesis that is too _______, an abduction contracture, or a medial socket wall encroaching the groin.

Causes of Swing Phase Problems
Abducted Gait – Causes include a prosthesis that is too long, an abduction contracture, or a medial socket wall encroaching the groin.

38

Causes of Swing Phase Problems
Circumducted Gait – Causes include a prosthesis that is too _______, too much knee friction making it difficult to bend the knee during swing-through, or an abduction contracture.

Causes of Swing Phase Problems
Circumducted Gait – Causes include a prosthesis that is too long, too much knee friction making it difficult to bend the knee during swing-through, or an abduction contracture.

39

Causes of Swing Phase Problems
Excessive Heel Rise – Causes include insufficient knee _______ or excessive KF moment (i.e., posterior foot or insufficient PF at heel strike).

Causes of Swing Phase Problems
Excessive Heel Rise – Causes include insufficient knee friction or excessive KF moment (i.e., posterior foot or insufficient PF at heel strike).

40

Causes of Swing Phase Problems
Foot Drag – Causes include inadequate _______, a prosthesis that is too _______, insufficient HF or KF, or weak PF of the nonprosthetic limb.

Causes of Swing Phase Problems
Foot Drag – Causes include inadequate suspension, a prosthesis that is too long, insufficient HF or KF, or weak PF of the nonprosthetic limb.

41

Causes of Swing Phase Problems
Terminal Swing Impact – Insufficient knee _______ may cause the amputee to deliberately and forcibly extend the knee.

Causes of Swing Phase Problems
Terminal Swing Impact – Insufficient knee friction may cause the amputee to deliberately and forcibly extend the knee.

42

UPPER LIMB PROSTHETICS
Unilateral amputees typically learn to perform most ADLs with their intact hand. B/l amputees often use their ________ for many ADLs. Functional UEx prostheses should be prescribed for highly motivated patients with realistic expectations. Residual limb shaping with bandages may be required for ________ to ________ months before prosthetic fitting. If fitting is not performed within a ________ to ________ month window after unilateral amputation, long-term prosthesis use is infrequently seen.

UPPER LIMB PROSTHETICS
Unilateral amputees typically learn to perform most ADLs with their intact hand. B/l amputees often use their feet for many ADLs. Functional UEx prostheses should be prescribed for highly motivated patients with realistic expectations. Residual limb shaping with bandages may be required for 1 to 2 months before prosthetic fitting. If fitting is not performed within a 3- to 6-month window after unilateral amputation, long-term prosthesis use is infrequently seen.

43

TR Prosthetics
Body-powered prostheses with hooks or hands are typically prescribed for manual laborers (the typical patient who is going to suffer a traumatic UEx amputation in the first place). Lifting up to ________ to ________ lbs can be expected. Longer residual limbs provide more lever arm and more pronation/supination and are better suited for heavy labor. ________ prostheses are often appropriate for relatively sedentary amputees (Fig. 4-12).

TR Prosthetics
Body-powered prostheses with hooks or hands are typically prescribed for manual laborers (the typical patient who is going to suffer a traumatic UEx amputation in the first place). Lifting up to 20 to 30 lbs can be expected. Longer residual limbs provide more lever arm and more pronation/supination and are better suited for heavy labor. Myoelectric prostheses are often appropriate for relatively sedentary amputees (Fig. 4-12).

44

TH Prosthetics
Longer residual limbs (up to 90% of original/expected length) are preferred. Function is usually much ________ than with a TR. A key difference for TH prostheses users is the need for an ________ unit. Harnessing and control systems are also different. Lifting between ________ and ________ lbs can be expected (more with a shoulder saddle). Length estimates for b/l TH amputees are 19% of patient height for the upper arm and 21% for the forearm component.

TH Prosthetics
Longer residual limbs (up to 90% of original/expected length) are preferred. Function is usually much poorer than with a TR. A key difference for TH prostheses users is the need for an elbow unit. Harnessing and control systems are also different. Lifting between 10 and 15 lbs can be expected (more with a shoulder saddle). Length estimates for b/l TH amputees are 19% of patient height for the upper arm and 21% for the forearm component.

45

Functional TDs
TDs are the most important functional part of the UEx prosthesis. They are classified as ________ or ________.

Functional TDs
TDs are the most important functional part of the UEx prosthesis. They are classified as active or passive.

46

Active TDs are broken into hooks and artificial hands. Hooks may have ________ with thumb- and fingerlike components. The proximal limb/prosthesis essentially functions to position the TD in space. Body-powered VO (Voluntary Opening) split-hooks are the most common and practical TDs. In these devices, the TD is closed at rest. Prehensile force is predetermined by the number of rubber bands in place (each rubber band requires ________ lbs of force to provide ________ lb of pinch force). Up to 10 bands can be used (typical nonamputee male pinch force is 15 to 20 lbs) (Fig. 4-13A).

Active TDs are broken into hooks and artificial hands. Hooks may have prehensors with thumb- and fingerlike components. The proximal limb/prosthesis essentially functions to position the TD in space. Body-powered VO (Voluntary Opening) split-hooks are the most common and practical TDs. In these devices, the TD is closed at rest. Prehensile force is predetermined by the number of rubber bands in place (each rubber band requires 5 lbs of force to provide 1 lb of pinch force). Up to 10 bands can be used (typical nonamputee male pinch force is 15 to 20 lbs) (Fig. 4-13A).

47

VC (Voluntary Closing) TDs provide a better control of closing pressure, but active ________ is required to maintain closure of the TD or items may be dropped (Fig. 4-13B).

VC (Voluntary Closing) TDs provide a better control of closing pressure, but active effort is required to maintain closure of the TD or items may be dropped (Fig. 4-13B).

48

Myoelectric hands offer spherical/palmar grasp with grip forces higher than body-powered TDs. They can have a lifelike appearance but are relatively ________. Two-site two-function controllers use different muscles to open and close the TD, while one-site two-function controllers use weak versus strong contractions of the same muscle to operate the TD.

Myoelectric hands offer spherical/palmar grasp with grip forces higher than body-powered TDs. They can have a lifelike appearance but are relatively fragile. Two-site two-function controllers use different muscles to open and close the TD, while one-site two-function controllers use weak versus strong contractions of the same muscle to operate the TD.

49

The most common prosthetic wrist is the ________ wrist, which allows passive pronation/supination but rotates when holding heavy objects. B/l amputees require at least one mechanical spring-assisted flexion wrist for access to the body midline. Most TH prosthetic ________ have an alternator lock, which alternately locks and unlocks with the same movement. With the elbow unlocked, body movements will flex or extend the elbow using a cable; when locked, the same cable operates the TD.

The most common prosthetic wrist is the friction wrist, which allows passive pronation/supination but rotates when holding heavy objects. B/l amputees require at least one mechanical spring-assisted flexion wrist for access to the body midline. Most TH prosthetic elbows have an alternator lock, which alternately locks and unlocks with the same movement. With the elbow unlocked, body movements will flex or extend the elbow using a cable; when locked, the same cable operates the TD.

50

The traditional suspension employs straps and cables, with a ________-________ socket for optimal fit. The outer wall is rigid and connects to other components; the inner wall must fit with the residual limb precisely or else the prosthesis may fail. The ________ socket can provide self-suspension w/o straps and is ideally preferred for the TH amputee. The ________ ________ socket provides self-suspension for a very short TR or elbow disarticulation by encasing the humeral condyles and can be used for externally powered prostheses. Proper fit of the Munster socket, however, precludes full elbow extension.

The traditional suspension employs straps and cables, with a double-walled socket for optimal fit. The outer wall is rigid and connects to other components; the inner wall must fit with the residual limb precisely or else the prosthesis may fail. The suction socket can provide self-suspension w/o straps and is ideally preferred for the TH amputee. The Munster supracondylar socket provides self-suspension for a very short TR or elbow disarticulation by encasing the humeral condyles and can be used for externally powered prostheses. Proper fit of the Munster socket, however, precludes full elbow extension.

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The body harness uses cables to allow body motion and effort to operate prosthetic components. The figure-of-8, generally for a ________ TR or more ________ amputation, also holds the socket firmly in place, usually with an elbow hinge and half-arm cuff or triceps pad. The figure-of-9, generally for a ________ TR or ________ disarticulation, requires a self-suspending socket but is more comfortable than the figure-of-8. The shoulder saddle with chest strap frees the opposite shoulder and relieves the pressure caused by the axillary loop of the figure-of-8. Heavy loads are better tolerated, but donning is difficult and cosmesis is inferior.

The body harness uses cables to allow body motion and effort to operate prosthetic components. The figure-of-8, generally for a short TR or more proximal amputation, also holds the socket firmly in place, usually with an elbow hinge and half-arm cuff or triceps pad. The figure-of-9, generally for a long TR or wrist disarticulation, requires a self-suspending socket but is more comfortable than the figure-of-8. The shoulder saddle with chest strap frees the opposite shoulder and relieves the pressure caused by the axillary loop of the figure-of-8. Heavy loads are better tolerated, but donning is difficult and cosmesis is inferior.

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Body-Powered Prosthesis Control
Glenohumeral (GH) Forward Flexion (TR, TH) – This natural movement provides excellent power and reach and can activate the ________ or ________ an elbow joint (Fig. 4-14A).

Body-Powered Prosthesis Control
Glenohumeral (GH) Forward Flexion (TR, TH) – This natural movement provides excellent power and reach and can activate the TD or flex an elbow joint (Fig. 4-14A).

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Body-Powered Prosthesis Control
Biscapular Abduction (________, shoulder disarticulation, TH, TR) – This movement can activate a TD, but the TD must stay relatively stationary. The forces generated are relatively ________ (Fig. 4-14B).

Body-Powered Prosthesis Control
Biscapular Abduction (forequarter, shoulder disarticulation, TH, TR) – This movement can activate a TD, but the TD must stay relatively stationary. The forces generated are relatively weak (Fig. 4-14B).

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Body-Powered Prosthesis Control
GH Depression, Extension, Abduction (TH) – This movement locks or unlocks an ________, but may be unnatural for some users and difficult to master (Fig. 4-14C).

Body-Powered Prosthesis Control
GH Depression, Extension, Abduction (TH) – This movement locks or unlocks an elbow, but may be unnatural for some users and difficult to master (Fig. 4-14C).

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Body-Powered Prosthesis Control
Scapular Elevation (not pictured) – This locks or unlocks the ________ and is easy to master. It requires a ________ ________.

Body-Powered Prosthesis Control
Scapular Elevation (not pictured) – This locks or unlocks the elbow and is easy to master. It requires a waist belt.

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Body-Powered Prosthesis Control
Chest Expansion/Scapular Adduction (not pictured) – This locks or unlocks the elbow. It is an awkward motion, but does not interfere with ________ operations.

Body-Powered Prosthesis Control
Chest Expansion/Scapular Adduction (not pictured) – This locks or unlocks the elbow. It is an awkward motion, but does not interfere with TD operations.