Exam 5: Prosthetics TransFem ReadGuide/Chart; Sockets, Suspensions Flashcards Preview

Bringman class fall 2015 > Exam 5: Prosthetics TransFem ReadGuide/Chart; Sockets, Suspensions > Flashcards

Flashcards in Exam 5: Prosthetics TransFem ReadGuide/Chart; Sockets, Suspensions Deck (74):
1

Transfemoral Prosthetics Reading Guide:

Contrast the knee disarticulation to the typical TF amputation. (6 points about each)

Transfem

  1. Amputation proximal to the anatomical knee joint
  2. limb can vary in length
  3. RL is likely to be a tapered cylinder- helps with donning/doffing
  4. Tapered cylinder shape is more challenging with prosthetic suspension
  5. suction suspension may be a good option
  6. The shorter the RL, the more difficult socket suspension and knee control is.

Disarticulation

  1. Amputation through the center of the anatomical knee joint
  2. normal adduction angle for LE is likely preserved
  3. longer lever arm
  4. bulbous shape due to retention of femur & its condyles- issue for donning/doffing
  5. But bulbous shape is good for enhancement of prosthetic suspension
  6. distal end of femur tolerated end-bearing pressure

2

Transfemoral Prosthetics Reading Guide:

 

Features of a transfem (as opposed to a disarticulation) (6)

  1. Amputation proximal to the anatomical knee joint
  2. limb can vary in length
  3. RL is likely to be a tapered cylinder- helps with donning/doffing
  4. Tapered cylinder shape is more challenging with prosthetic suspension
  5. suction suspension may be a good option
  6. The shorter the RL, the more difficult socket suspension and knee control is.

3

Transfemoral Prosthetics Reading Guide:

Featurs of a disarticulation (in contrast to a transfem) (6)

  1. Amputation through the center of the anatomical knee joint
  2. normal adduction angle for LE is likely preserved
  3. longer lever arm
  4. bulbous shape due to retention of femur & its condyles- issue for donning/doffing
  5. But bulbous shape is good for enhancement of prosthetic suspension
  6. distal end of femur tolerated end-bearing pressure

4

Transfemoral Prosthetics Reading Guide:

Describe the relative metabolic cost of ambulation and the functional implications for the elderly TF amputee. (5 points)

  1. The shorter the RL, the more energy required in gait.
  2. 4 things affecting energy: 1) weight of prosthesis, 2) quality of the socket fit, 3) accuracy of alignment of prosthesis, 4) functional characteristics of prosthetic components
  3. Increased energy expenditure= more O2 consumed, increased HR/BP, reduction in comfortable self selected walking speed.
  4. High energy need of short RL  means that elderly will be limited community ambulators- may require AD and restricted to flat terrain
  5. Bilat elderly transfem may opt for a WC for ambulation

5

Transfemoral Reading Guide

4 things affecting energy:

4 things affecting energy:

  1. weight of prosthesis,
  2. quality of the socket fit,
  3. accuracy of alignment of prosthesis,
  4. functional characteristics of prosthetic components

6

Transfemoral Reading Guide

How does increased inergy expenditure affect self-selected walking speed?

Increased energy expenditure= more O2 consumed, increased HR/BP, reduction in comfortable self selected walking speed.

7

Transfemoral Reading Guide

Describe the functional implications for the elderly TF amputee.

  • Short residual limb
  • bilateral amputation

  1. High energy need of short RL  means that elderly will be limited community ambulators- may require AD and restricted to flat terrain
  2. Bilat elderly transfem may opt for a WC for ambulation

8

Transfemoral Reading Guide

What is a Quadirilateral Socket? (7-9)

 

  • Looks squarish
  • Remained the socket of choice until the mid-1980s.
  • Has four distinct walls
  • Two Primary functions
    1. provide for weight bearing during the stance phase of gait a
    2. allow the hip and thigh muscles to function at maximum potential during the stance phase
  • A flat posterior shelf, the ischial seat, is the primary weight bearing surface for the ischium and gluteal muscles.
  • Anterior wall contours create a posterior directed force at the anatomical Scarpa’s triangle, which is intended to stabilize the ischium on its prosthetic seate
  • The socket is narrower in its anterior-posterior dimension than its medial-lateral dimension.

 

The quadrilateral socket is designed for transfemoral (above knee) amputees. The weight bearing in this socket is primarily on the ischium and the gluteal musculature (buttocks). This combination of bone and muscle rests on the posterior brim (back edge) of the socket which creates a wide seat parallel to the ground. This socket can be held in place on the residual limb with suction, a Silesian or TES belt, or by the use of a soft insert with a suspension locking mechanism. This design aids in ease of sitting and, in comparison to the ischial containment socket, is more successful on long, firm residual limbs. (http://www.plor.net/downloads/resources/prosthetics/transfemoral-amputation-and-knee-disarticulation/Prosthetics.QuadrilateralSocket.pdf)

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9

What is an Ischial Containment Socket? (7-10)

  • newer
  • Analogous to the TSB transtib socket.
  • It is much better than the quadrilateral socket
  • Trim line contains the the ischial tuberosity and creates  boney lock that provides mediolateral stability and reduces the likelihood of socket rotation.
  • When compared to the quad socket, the most obvious difference is the narrow medial-lateral dimension that is highly contoured around the ischial -ramal complex
  • Developed out of the ideas of Ivan Long and John Sabolich. Long believed that by aligning the distal femur over the center of the knee and through the center of the foot, the wearer of the prosthesis could bring their residual limb into a normal anatomical position and walk more naturally. Sabolich expanded on Long’s ideas to make the contoured anterior trochanteric-controlled alignment method which maintains an adducted position and controls socket rotation by containing the ischial tuberosity within the contours of the socket.
    • Long’s socket design was part of a frontal plane alignment procedure that became known as “ Long’s Line.”
    • His ideas were expanded on by John Sabolich to make the contoured anterior trochanteric-controlled alignment method (CAT-CAM) socket.
    • Since the CAT-CAM a series of designs have developed that have become known as ischial containment or  Ischial-ramal containment sockets (ICS)
  • Compared to quad: Narrowed medial-lateral dimension and increased the anteroposterior dimension. The narrow medial-lateral walls better supported the femur to prevent lateral shifting of the socket during stance. The larger anteroposterior dimension allowed better muscle function because there was additional room for muscles to contract.

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10

Transfemoral Reading Guide: Contrast the quadrilateral socket to the ischial containment socket for:

  • Dimensions
  • Weight Bearing
  • Femur Position
  • Gait
  • Energy Expenditure
  • Comfort
  • Medial-Lateral Pelvic Stability

 

  • Dimensions-
    • The quadrilateral socket is narrower in its anterior-posterior dimension than its medial-lateral dimension. It is wider in its medial-lateral dimension, which caused an abnormal abduction angle of the femur.  (allows the socket to displace laterally during midstance, thus increasing pressure to the perineal tissues and decreasing the efficiency of the glute med muscle).
    • The ICS has a narrower mediolateral dimension and larger anteroposterior dimension to support the femur and prevent lateral shifting of the socket during weight bearing.  The bigger anteroposterior socket dimension also enhances muscle function by producing more room to accommodate contraction than was possible with the AP dimensions of the quad socket
  • Weight-bearing-
    • quad socket- a flat posterior shelf, the ischial seat, is the primary WB surface for the ischium and gluteal muscles
    • ICS - more like total surface bearing. There is no ischial seat and weight bearing occurs predominantly on the soft tissues of the thigh, gluteal region, and medial aspect of the ischium. (pg 671-672; third edition)
  • Femur position-
    • Quadrilateral has wider mediolateral walls which abducted the leg more than was ideal and contributed to a wide based gait and a Trendelenburg gait where the individual leaned toward their prosthetic side for compensation.
    • ICS is more narrow mediolaterally and allows more anterior posterior room. This means the femur is in a more natural adducted position. The lateral socket wall is contoured in adduction, with additional pressure against the posterior shaft of the femur for added stability and rotational control.
    • It is debated that femur position is affected by surgery, not the socket.  (however, there were pictures in the book and it seemed generally accepted that the ICS keeps the femur in more natural alignment, as opposed to the abnormally abducted resting position in the quad socket)
  • Gait
    • The ICS results in a more natural gait because of better femoral alignment and less likelihood of socket rotation. There is less need for compensation for a wide based gait (see medial-lateral pelvic stability)
    • Energy expenditure
    • ICS is is more efficient because it allows a more natural gait which uses less energy than the quad socket.  (see medial-lateral pelvic stability)
  • Comfort
    • Chart says there is more area for pressure distribution in the ICS compared to the quadrilateral, so the ICS is more comfortable than the quadrilateral
    • Other reasons I imagine the ICS socket is more comfortable are as follows: It more closely resembles the shape of a thigh. The brim of the socket captures more of the adductor muscle complex than does the quad socket and prevents pinching in the case of an adductor roll. It reduces socket rotation on the limb, increase the efficiency of gait, and distributes weight more evenly (pg 671, third edition).
  • Medial-lateral pelvic stability- (see “Pelvic Stability”  pg 669 of third edition)
    • The design of a quad socket primarily applies stabilizing forces in the anteroposterior plane so that there is little to keep the femur from drifting laterally within the socket.
      • Consequently, the  pelvis drops when the intact limb is in swing phase. To compensate, the prosthetic wearer often leans tor lurches laterally towards the prosthetic side. This strategy improves swing clearance but also results in a wide-based, energy taxing gait.  Because the femur is held in an abnormally abducted position, circumduction of the prosthesis during swing is likely to occur.
    • ICS has a narrower medial-lateral dimension than the Quad socket and is highly contoured to match the unique shape of the user’s residual limb,
    • ICS provides better mediolateral stability  (which is a common problem for transfem amputees, especially those with short residual limbs, or who have developed flexion, abduction, and external rotation contractures.
    • In contrast to the quad socket, the IRC socket attempts to hold the femur in its normal adducted position during stance with an upward and medially directed force along the length of the lateral femur. This strategy enhances prosthetic wearer’s ability to maintain a level pelvis and improves the quality of functional gait.

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11

Transfemoral Reading Guide: Contrast the quadrilateral socket to the ischial containment socket for:

  • Dimensions

Dimensions-

  • The quadrilateral socket is narrower in its anterior-posterior dimension than its medial-lateral dimension. It is wider in its medial-lateral dimension, which caused an abnormal abduction angle of the femur.  (allows the socket to displace laterally during midstance, thus increasing pressure to the perineal tissues and decreasing the efficiency of the glute med muscle).
  • The ICS has a narrower mediolateral dimension and larger anteroposterior dimension to support the femur and prevent lateral shifting of the socket during weight bearing.  The bigger anteroposterior socket dimension also enhances muscle function by producing more room to accommodate contraction than was possible with the AP dimensions of the quad socket

12

Transfemoral Reading Guide: Contrast the quadrilateral socket to the ischial containment socket for:

  • Weight Bearing

Weight-bearing-

quad socket- a flat posterior shelf, the ischial seat, is the primary WB surface for the ischium and gluteal muscles

ICS - more like total surface bearing. There is no ischial seat and weight bearing occurs predominantly on the soft tissues of the thigh, gluteal region, and medial aspect of the ischium. (pg 671-672; third edition)

13

Transfemoral Reading Guide: Contrast the quadrilateral socket to the ischial containment socket for:

  • Femur Position

Femur position-

  • Quadrilateral has wider mediolateral walls which abducted the leg more than was ideal and contributed to a wide based gait and a Trendelenburg gait where the individual leaned toward their prosthetic side for compensation.
  • ICS is more narrow mediolaterally and allows more anterior posterior room. This means the femur is in a more natural adducted position. The lateral socket wall is contoured in adduction, with additional pressure against the posterior shaft of the femur for added stability and rotational control.
  • It is debated that femur position is affected by surgery, not the socket.  (however, there were pictures in the book and it seemed generally accepted that the ICS keeps the femur in more natural alignment, as opposed to the abnormally abducted resting position in the quad socket)

14

Transfemoral Reading Guide: Contrast the quadrilateral socket to the ischial containment socket for:

  • Gait

Gait

The ICS results in a more natural gait because of better femoral alignment and less likelihood of socket rotation. There is less need for compensation for a wide based gait (see medial-lateral pelvic stability)

15

Transfemoral Reading Guide: Contrast the quadrilateral socket to the ischial containment socket for:

  • Energy Expenditure

Energy expenditure

ICS is is more efficient because it allows a more natural gait which uses less energy than the quad socket.  (see medial-lateral pelvic stability)

16

Transfemoral Reading Guide: Contrast the quadrilateral socket to the ischial containment socket for:

  • Comfort

 

Comfort

  • Chart says there is more area for pressure distribution in the ICS compared to the quadrilateral, so the ICS is more comfortable than the quadrilateral
  •   imagine the ICS socket is more comfortable. It more closely resembles the shape of a thigh. The brim of the socket captures more of the adductor muscle complex than does the quad socket and prevents pinching in the case of an adductor roll. It reduces socket rotation on the limb, increase the efficiency of gait, and distributes weight more evenly (pg 671, third edition).

17

Transfemoral Reading Guide: Contrast the quadrilateral socket to the ischial containment socket for:

  • Medial-Lateral Pelvic Stability

Medial-lateral pelvic stability- (see “Pelvic Stability”  pg 669 of third edition)

  • The design of a quad socket primarily applies stabilizing forces in the anteroposterior plane so that there is little to keep the femur from drifting laterally within the socket.
    • Consequently, the  pelvis drops when the intact limb is in swing phase. To compensate, the prosthetic wearer often leans tor lurches laterally towards the prosthetic side. This strategy improves swing clearance but also results in a wide-based, energy taxing gait.  Because the femur is held in an abnormally abducted position, circumduction of the prosthesis during swing is likely to occur.
  • ICS has a narrower medial-lateral dimension than the Quad socket and is highly contoured to match the unique shape of the user’s residual limb,
  • ICS provides better mediolateral stability  (which is a common problem for transfem amputees, especially those with short residual limbs, or who have developed flexion, abduction, and external rotation contractures.
  • In contrast to the quad socket, the IRC socket attempts to hold the femur in its normal adducted position during stance with an upward and medially directed force along the length of the lateral femur. This strategy enhances prosthetic wearer’s ability to maintain a level pelvis and improves the quality of functional gait.

18

Transfemoral Reading Guide

Contrast the rigid and flexible socket. (features, advantages, disadvantages)

Rigid socket

  • Features
    • consists of a resin-laminated or thermoformed plastic socket that is intended to
    • have an intimate, total contact fit over the entire surface of the residual limb
    • Prosthetic socks are often worn as a soft interface between the socket and residual limb
  • Advantages
    • Socket is durable, easy to clean, and often less bulky and expensive to produce than flexible sockets
  • Disadvantage   
    • More difficult to adjust the fit of the rigid socket,
      • especially for pt. with bony or
      • sensitive residual limbs

Flexible Socket

  • Features
    • A FS is vacuum formed using any number of flexible thermoplastic materials
    • Encased in a rigid frame, which provides support during WB and helps to maintain socket shape.
  • Advantages
    • Accommodates to change in muscle shape during contraction and can be easily modified after initial fabrication to provide relief for bony prominences
    • May also be more comfortable to wear, especially in sitting, because there are no hard ridges at the brim to impinge on the groin
    • They are especially useful if suction suspension is desired
  • Disadvantage
    • less durable
    • more bulky to wear (requires a socket and a frame)
    • more expensive to produce

19

Transfemoral Reading Guide: rigid socket (contrasted to flexible socket)

  • Features (3)
  • Advantages (3)
  • Disadvantages (1-3)

Rigid socket

  • Features
    • consists of a resin-laminated or thermoformed plastic socket that is intended to
    • have an intimate, total contact fit over the entire surface of the residual limb
    • Prosthetic socks are often worn as a soft interface between the socket and residual limb
  • Advantages
    • Socket is durable,
    • easy to clean, and
    • often less bulky and expensive to produce than flexible sockets
  • Disadvantage   
    • More difficult to adjust the fit of the rigid socket,
      • especially for pt. with bony or
      • sensitive residual limbs

20

Transfemoral Reading Guide: flexible socket (contrasted to rigid socket)

Features (2)

Advantages (3)

Disadvantages (3)

Flexible Socket

  • Features
    • A FS is vacuum formed using any number of flexible thermoplastic materials
    • Encased in a rigid frame, which provides support during WB and helps to maintain socket shape.
  • Advantages
    • Accommodates to change in muscle shape during contraction and can be easily modified after initial fabrication to provide relief for bony prominences
    • May also be more comfortable to wear, especially in sitting, because there are no hard ridges at the brim to impinge on the groin
    • They are especially useful if suction suspension is desired
  • Disadvantage
    • less durable
    • more bulky to wear (requires a socket and a frame)
    • more expensive to produce

21

How does the flexible socket fit into the grand scheme of things? (where would we find it used?)

A flexible socket is usually incorporated into one of the more modern socket designs (TSB for transtibial and ICS for transfemoral). It enhances total surface bearing

22

Describe Pull-in Suction:

  • what is it?
  • Steps for donning? (3-7)
  • Indications (2)
  • Advantages (2)
  • Disadvantages (3)

Pull-in suction (same as Traditional Pull-in suction)

What is it?

  • use negative air pressure, skin to socket contact, and muscle tension to hold the socket onto the limb
  • Only creates a negative pressure differential when prosthesis is in swing phase (because of passive expulsion valve)

Steps for Donning

  • Can be donned in several ways ways
    1. donning sock (cotton stockinette or similar material)
    2. Donning sleeve (parachute nylon or similar material)
    3. elastic bandage to pull the residual limb into the socket
    4. add a lubricant to the skin (e.g. powder) to facilitate the residual limb sliding into the socket
      • The liquid powder dries quickly, and suction is achieved.
  • Once the limb is well seated in the socket, the sock, sleeve, or elastic wrap is pulled through the valve housing at the distal socket, the air and expulsion valve is then screwed back into place
  • The air-expulsion valve is then “burped” by pushing or pulling the valve button, to release any trapped air.

Indications:

  1. Requires mature residual limb
  2. Requires good stand bal & dexterity to don

Advantages:

  1. Additional benefits -Wearer often reports enhanced prosthetic control and a better proprioceptive sense of the prosthesis during walking

Disadvantages

  1. Difficult to maintain suction if edema fluctuates
    • Requires mature residual limb
  2. The high shearing forces associated with donning a suction socket
    • may preclude its use for patients with fragile or sensitive skin, painful trigger points, or significant scarring or adhesions.
  3. must have considerable agility and balance on the part of the wearer

A image thumb
23

Describe Pull-in Suction:

what is it?

Pull-in suction (same as Traditional Pull-in suction)

What is it?

  • use negative air pressure, skin to socket contact, and muscle tension to hold the socket onto the limb
  • Only creates a negative pressure differential when prosthesis is in swing phase (because of passive expulsion valve)

A image thumb
24

Describe Pull-in Suction:

  • Steps for donning? (3-7)

Steps for Donning

  1. Can be donned in several ways ways
    • donning sock (cotton stockinette or similar material)
    • Donning sleeve (parachute nylon or similar material)
    • elastic bandage to pull the residual limb into the socket
    • add a lubricant to the skin (e.g. powder) to facilitate the residual limb sliding into the socket
      • The liquid powder dries quickly, and suction is achieved.
  2. Once the limb is well seated in the socket, the sock, sleeve, or elastic wrap is pulled through the valve housing at the distal socket, the air and expulsion valve is then screwed back into place
  3. The air-expulsion valve is then “burped” by pushing or pulling the valve button, to release any trapped air.

25

Describe Pull-in Suction:

  • Indications (2)

Indications:

  1. Requires mature residual limb
  2. Requires good stand bal & dexterity to don

26

Describe Pull-in Suction:

  • Advantages (2)

 

Advantages:

  • Additional benefits -Wearer often reports
    1. enhanced prosthetic control and a
    2. better proprioceptive sense of the prosthesis during walking

27

Describe Pull-in Suction:

  • Disadvantages (3)

Disadvantages

  1. Difficult to maintain suction if edema fluctuates
    • Requires mature residual limb
  2. The high shearing forces associated with donning a suction socket
    • may preclude its use for patients with fragile or sensitive skin, painful trigger points, or significant scarring or adhesions.
  3. must have considerable agility and balance on the part of the wearer

28

Roll-On suspension liners are incorporated in the following types of suspensions (4)

Included in the following:

  1. shuttle lock system,
  2. lanyard system,
  3. cushion liner with air expulsion valve, and
  4. A type of liner is also used in elevated vacuum (as a wicked liner)

29

T/F

Roll-on liners can be worn against the skin

30

true

They are usually worn against the skin

(exception may be if they have a "liner liner" [a type of sheath])

31

What are the three materials that roll-on liners can be made from (and what does Dr. Mincer usually call them)?

  1. silicone
  2. urethane
  3. elastomer

Dr. Mincer sometimes refers to roll-on liners as a silicone liner (or something that includes silicone, might be pull-on silicone liner, or roll-on silicone liner)

32

How is a roll-on liner donned?

Don by turning inside out and then rolling on

(some of the vidoes showed putting alcohol on the outside of the liner to help it roll on, then alcohol evaporated. I think someone using VASS used ointment on the residual limb before applying the liner)

33

Four advantages (including one major advantage) of roll-on liner

  1. Major advantage: significant reduction in friction and shear
  2. Donning procedure is simple, and can be accomplished while seated
  3. Useful for individuals with short RL
  4. Useful for individuals with discomfort using traditional pull-in suction method

34

Four disadvantages in using a roll-on liner

  1. Expense and durability
    • become worn or torn
    • replace 2-3 times a year
  2. Increase skin temp and perspiration
  3. Rashes or skin irritation
  4. Must clean daily (to prevent buildup of perspiration and bacteria)

35

how often do gel liners usually need to be replaced?

replace 2-3 times a year

36

TF Shuttle-lock or Lanyard suspension

  • What is it?
  • Donning procedure
  • Indications (1)
  • Advantages (2)
  • Disadvantages (2)

What is it?/Donning Procedure

  • TF Sockets and suspension chart: "Gel liner with pin or cable, similar to TT"
  • Shuttle lock system is called a locking liner- has an external distal cap where a serrated pin screw stick out. Pin screw is intended to go into shuttle lock at the bottom of the socket. To remove, a button must be pressed to release lock
    • I have a note that Dr. Mincer said they are seldom used anymore due to common mechanical failure that caused the prosthesis to get stuck on the RL
      • Vacuum suction has largely replaced the shuttle-lock
      • But the chart says they are widely used - emailed Dr. mincer to ask about this.
  • Lanyard uses locking liner but with a lanyard (strap or cord) attached to the distal cap and threaded through lateral opening in socket. The this is routed through the distal socket to pull the RL into the socket. The lanyard is then attached to the external lateral aspect of the socket using velcro. Many designs also have an additional loop attached to the liner proximally (could have a ski-boot like strap proximally)

Indications (1)

  • Used to be Widely used
    • Used to be widely used (esp lanyard now, instead of pin and shuttle because of the mechanical problems) but in the past year or two vacuum assisted has moved to the front

Advantages (2)

  1. Comfortable due to cushion
  2. Secure

Disadvantages (2)

  1. Pin can have mechanical problems
  2. Traction on skin

A image thumb
37

TF Shuttle-lock or Lanyard suspension

  • What is it?

What is it?/Donning Procedure

  • TF Sockets and suspension chart: "Gel liner with pin or cable, similar to TT"
  • Shuttle lock system is called a locking liner- has an external distal cap where a serrated pin screw stick out. Pin screw is intended to go into shuttle lock at the bottom of the socket. To remove, a button must be pressed to release lock
    • I have a note that Dr. Mincer said they are seldom used anymore due to common mechanical failure that caused the prosthesis to get stuck on the RL
      • Vacuum suction has largely replaced the shuttle-lock
      • But the chart says they are widely used - emailed Dr. mincer to ask about this.
  • Lanyard uses locking liner but with a lanyard (strap or cord) attached to the distal cap and threaded through lateral opening in socket. The this is routed through the distal socket to pull the RL into the socket. The lanyard is then attached to the external lateral aspect of the socket using velcro. Many designs also have an additional loop attached to the liner proximally (could have a ski-boot like strap proximally)

A image thumb
38

TF Shuttle-lock or Lanyard suspension

  • Donning procedure

What is it?/Donning Procedure

  • TF Sockets and suspension chart: "Gel liner with pin or cable, similar to TT"
  • Shuttle lock system is called a locking liner- has an external distal cap where a serrated pin screw stick out. Pin screw is intended to go into shuttle lock at the bottom of the socket. To remove, a button must be pressed to release lock
    • I have a note that Dr. Mincer said they are seldom used anymore due to common mechanical failure that caused the prosthesis to get stuck on the RL
      • Vacuum suction has largely replaced the shuttle-lock
      • But the chart says they are widely used - emailed Dr. mincer to ask about this.
  • Lanyard uses locking liner but with a lanyard (strap or cord) attached to the distal cap and threaded through lateral opening in socket. The this is routed through the distal socket to pull the RL into the socket. The lanyard is then attached to the external lateral aspect of the socket using velcro. Many designs also have an additional loop attached to the liner proximally (could have a ski-boot like strap proximally)

A image thumb
39

TF Shuttle-lock or Lanyard suspension

  • Indications (1)

Indications (1)

  • Used to be Widely used

    • Used to be widely used (esp lanyard now, instead of pin and shuttle because of the mechanical problems) but in the past year or two vacuum assisted has moved to the front

40

TF Shuttle-lock or Lanyard suspension

  • Advantages (2)

Advantages (2)

  1. Comfortable due to cushion
  2. Secure

41

TF Shuttle-lock or Lanyard suspension

  • Disadvantages (2)

Disadvantages (2)

  1. Pin can have mechanical problems
  2. Traction on skin

42

What are three types of TF suction suspension? (and a very brief description of each - a few words)

  1. Traditional Suction
    1. (bare skin to socket wall)
  2. Roll-on Silicone liner (chart) / Suction via cushion liner and valve (reading guide)
    • Generally referred to as cushion liner (from book?)
    • (gel liner between skin and socket wall, but no pin)
  3. Elevated Vacuum (similar to VASS, Dr. Mincer heasitantly said we could think of them as the same category)
    • Similar to roll-on liner suction but with a pump applied after donning

43

alternate names for roll-on sillicone liner (as listed in the chart)

  1. Roll-on Silicone liner (chart)
  2. Suction via cushion liner and valve (reading guide)
  3. Generally referred to as cushion liner (from book?)

44

Suction via cushion liner and valve

  • What is it?
  • Donning procedure?
  • Indications (2)
  • Advantages (3)
  • Disadvantages (3)

What is it?

  • Called Suction via cushion liner and valve in reading guide, Referred to roll-on sillicone liner in chart, and Generally referred to as cushion liner (from book)
  • gel liner between skin and socket wall, but no pin
  • Similar to the traditional skin suction socket method mentioned previously (but with a liner)

Donning Procedure

  • After the liner is donned on the RL, it is pushed into the socket, creating a negative pressure environment by expelling air through the expulsion valve. (usually step on it to get air out)

Indications:

  • Requires
    • good standing balance and
    • dexterity to don (same as traditional suction)

Advantages (3)

  1. Easier to don than traditional suction
  2. More energy efficient gait
  3. More cushion

Disadvantages (3)

  1. Liners need frequent replacement
  2. ­heat & perspiration
  3. Difficult to maintain suction if edema fluctuates

45

Suction via cushion liner and valve

  • What is it?

What is it?

  • Called Suction via cushion liner and valve in reading guide, Referred to roll-on sillicone liner in chart, and Generally referred to as cushion liner (from book)
  • gel liner between skin and socket wall, but no pin
  • Similar to the traditional skin suction socket method mentioned previously (but with a liner)

46

Suction via cushion liner and valve

  • Donning procedure?

Donning Procedure

  • After the liner is donned on the RL, it is pushed into the socket, creating a negative pressure environment by expelling air through the expulsion valve (usually step on it to get air out).

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Suction via cushion liner and valve

  • Indications (2)

Indications:

  • Requires
    • good standing balance and
    • dexterity to don (same as traditional suction)

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Suction via cushion liner and valve

  • Advantages (3)

Advantages (3)

  1. Easier to don than traditional suction
  2. More energy efficient gait
  3. More cushion

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Suction via cushion liner and valve

  • Disadvantages (3)

Disadvantages (3)

  1. Liners need frequent replacement
  2. ­heat & perspiration
  3. Difficult to maintain suction if edema fluctuates

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Elevated Vacuum

  • What is it?
  • Donning procedure
  • Indications (1)
  • Advantages (4)
  • Disadvantages (2)

What is it?

  • Not the same as suction suspension.
  • Like suction suspension in that it uses a difference in atmospheric pressure to suspend and secure the socket to the residual limb
    • Suction suspension creates negative pressure only during prosthesis unloading (swing phase)
    • Vacuum creates negative pressure at all times (does not depend on limb position)
  • A vacuum pump creates negative pressure to remove air from a sealed environment between the total surface bearing socket and a wicked-liner
  • Similar to roll-on liner suction but with a pump applied after donning

Donning procedure

  • Don like suction suspension via cushion liner (roll-on silicone liner) but use external (vacuum) pump to create suction while seated instead of with one-way valve with weight bearing. 

Indications (1)

  • none listed.

Advantages (4)

  1. Can be donned in sitting
  2. Less volume fluctuation
  3. Better RL circulation
  4. Virtually eliminates pistoning

Disadvantages (2)

  1. Liners need frequent replacement
  2. ­increased heat and perspiration

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Elevated Vacuum

  • What is it?

What is it?

  • Not the same as suction suspension.
  • Like suction suspension in that it uses a difference in atmospheric pressure to suspend and secure the socket to the residual limb
    • Suction suspension creates negative pressure only during prosthesis unloading (swing phase)
    • Vacuum creates negative pressure at all times (does not depend on limb position)
  • A vacuum pump creates negative pressure to remove air from a sealed environment between the total surface bearing socket and a wicked-liner
  • Similar to roll-on liner suction but with a pump applied after donning

52

Elevated Vacuum

  • Donning procedure

Donning procedure

  • Don like suction suspension via cushion liner (roll-on silicone liner) but use external (vacuum) pump to create suction while seated instead of with one-way valve with weight bearing. 

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Elevated Vacuum

  • Indications (1)

Indications (1)

  • in the past year or two vacuum assisted has moved to the front (most commonly used suspension system) in place of pin and shuttle or lanyard suspension

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Elevated Vacuum

  • Advantages (4)

Advantages (4)

  1. Can be donned in sitting
  2. Less volume fluctuation
  3. Better RL circulation
  4. Virtually eliminates pistoning

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Elevated Vacuum

  • Disadvantages (2)

Disadvantages (2)

  1. Liners need frequent replacement
  2. ­increased heat and perspiration

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Two types of soft belts (TF suspensions)

Total Elastic Suspension (TES)

Silesian belt

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Silesian Belt

  • What is it?
  • Indications (2)
  • Advantages (1)
  • Disadvantages (1)

What is it?

  • Usually made from leather or lightweight webbing
  • Is attached to the lateral aspect of the socket, encircles the pelvis, then runs through a loop or buckle on the anterior of the socket

Indications

  1. Used as auxiliary suspension with suction
  2. May provide adequate suspension for individuals with long residual limbs who are not expected to be vigorous ambulators the SB (as a sole suspension)

Advantages

  • Better control of rotation than TES

Disadvantages

  • the problem with using this as the sole means of suspension lies with its inability to control residual limb rotation within the socket

A image thumb
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Silesian Belt

  • What is it?

What is it?

  • Usually made from leather or lightweight webbing
  • Is attached to the lateral aspect of the socket, encircles the pelvis, then runs through a loop or buckle on the anterior of the socket

A image thumb
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Silesian Belt

  • Indications (2)

 

Indications

  1. Used as auxiliary suspension with suction
  2. May provide adequate suspension for individuals with long residual limbs who are not expected to be vigorous ambulators the SB (as a sole suspension)

A image thumb
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Silesian Belt

  • Advantages (1)

Advantages

  • Better control of rotation than TES

A image thumb
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Silesian Belt

  • Disadvantages (1)

Disadvantages

  • the problem with using this as the sole means of suspension lies with its inability to control residual limb rotation within the socket

A image thumb
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Total Elastic Suspension

  • What is it?
  • Indications (4)
  • Advantages (3)
  • Disadvantages (3)

What is it?

  • Neoprene, like transtibial sleeve suspension but anchors around pelvis
  • reminds me of the sleeve suspension from transtib
  • Typically made of elastic neoprene material (like a wet suit)
  • Distal sleeve of TES belt fits snugly around the proximal half of the ghigh section of the prosthesis. The neoprene belt encircles the waist and attaches in front with velcro

Indications (4)

  • Used as auxiliary suspension with suction (same as Silesian belt)
    • excellent auxiliary suspension system
      • could be when playing sports or engaging in high activity
  • often chosen for
    1. recent amputee with RL that has not matured to stable size
    2. older pt’s who are unable to use the pull-in suction or roll-on liners because of UE weakness or pain
    3. those with easily irritated skin or adhesions who cannot tolerate suction 

Advantages (3)

  1. Easy to don
  2. Comfortable to wear
  3. Excellent auxiliary suspension system

Disadvantages (3)

  1. major disadvantage: limited durability, especially for active ambulators
  2. major disadvantage: tendency to retain heat
  3. Cannot control residual limb rotation adequately within the socket (even worse than silesian belt)

A image thumb
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Total Elastic Suspension

  • What is it?

What is it?

  • Neoprene, like transtibial sleeve suspension but anchors around pelvis
  • reminds me of the sleeve suspension from transtib
  • Typically made of elastic neoprene material (like a wet suit)
  • Distal sleeve of TES belt fits snugly around the proximal half of the ghigh section of the prosthesis. The neoprene belt encircles the waist and attaches in front with velcro

A image thumb
64

Total Elastic Suspension

  • Indications (4)

Indications (4)

  • Used as auxiliary suspension with suction (same as Silesian belt)
    • excellent auxiliary suspension system
      • could be when playing sports or engaging in high activity
  • often chosen for
    1. recent amputee with RL that has not matured to stable size
    2. older pt’s who are unable to use the pull-in suction or roll-on liners because of UE weakness or pain
    3. those with easily irritated skin or adhesions who cannot tolerate suction 

A image thumb
65

Total Elastic Suspension

  • Advantages (3)

Advantages (3)

  1. Easy to don
  2. Comfortable to wear
  3. Excellent auxiliary suspension system

A image thumb
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Total Elastic Suspension

  • Disadvantages (3)

Disadvantages (3)

  1. major disadvantage: limited durability, especially for active ambulators
  2. major disadvantage: tendency to retain heat
  3. Cannot control residual limb rotation adequately within the socket (even worse than silesian belt)

A image thumb
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What is the only TF suspension that provides ML stability?

Pelvic band and hip joint

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Pelvic Band and hip joint

  • What is it?
  • Indications (1-3)
  • Advantages (2)
  • Disadvantages (4)

What is it?

  • Pelvic belt is made of leather and attached to the prosthesis by means of a metal hip joint. Recently lighter weight plastic materials have been used as an alternative to the metal joint
  • Joint should be positioned just superior and anterior to the greater trochanter

Indications (1-3)

  • Short, weak, unstable RL
    • Traditionally the suspension of choice for those with short RLs

Advantages (2)

  1. No need for suction
  2. Adds ML hip stability

Disadvantages (4)

  1. Heavy
  2. Cosmesis (bulkiness under clothing)
  3. No movement in frontal plane allowed
  4. problematic in sitting (uncomfortable)

*** Picture of pelvic belt is on the left (the right is a silesian belt)

A image thumb
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Pelvic Band and hip joint

  • What is it?

What is it?

  • Pelvic belt is made of leather and attached to the prosthesis by means of a metal hip joint. Recently lighter weight plastic materials have been used as an alternative to the metal joint
  • Joint should be positioned just superior and anterior to the greater trochanter

 

*** Picture of pelvic belt is on the left (the right is a silesian belt)

A image thumb
70

Pelvic Band and hip joint

  • Indications (1-3)

Indications (1-3)

  • Short, weak, unstable RL
    • Traditionally the suspension of choice for those with short RLs

 

*** Picture of pelvic belt is on the left (the right is a silesian belt)

A image thumb
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Pelvic Band and hip joint

  • Advantages (2)

Advantages (2)

  1. No need for suction
  2. Adds ML hip stability

*** Picture of pelvic belt is on the left (the right is a silesian belt)

A image thumb
72

Pelvic Band and hip joint

  • Disadvantages (4)

Disadvantages (4)

  1. Heavy
  2. Cosmesis (bulkiness under clothing)
  3. No movement in frontal plane allowed
  4. problematic in sitting (uncomfortable)

*** Picture of pelvic belt is on the left (the right is a silesian belt)

A image thumb
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TF Sockets and Suspensions Chart:

Quadrilateral Socket

  • Indications (1)
  • Advantages (1)
  • Disadvantages (3)

Indications (1)

  • Long time users of this socket (outdated, but some may be attached to their socket or it may work well for them)

Advantages (1)

  • none listed

Disadvantages (3)

  • Often results in compensated trendellenburg gait
  • increased pressure on ischeial tuberosity
  • less area for pressure distribution so less comfortable

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TF Sockets and Suspensions Chart:

Ischial Containment Socket

  • Indications (1)
  • Advantages (3)
  • Disadvantages (1)

Indications (1)

  • Virtually all new wearers (it is the modern up-to-date socket)

Advantages (3)

  • more femoral stability in frontal plane results in
    1. results in mechanical advantage for abductors
      • results in less trendelenburg gait

Disadvantages (1)

  • Very high trimlines