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MVMT SCI II > LE PROSTHETICS > Flashcards

LE PROSTHETICS Flashcards

1
Q

Alignment

A

looking at whole relationship between all componentry, socket, patient anatomy to get most optimal gait possible

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2
Q

Pylon

A

Pylon is a rigid, usually tubular structure between the socket (or knee unit) and the foot that provides a weight bearing shock-absorbing support shaft for the prosthesis.

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3
Q

K-level

A

Determines what insurance will pay for an individual that needs a prosthesis –> where we think they will get with proper rehabilitation

score assigned when evaluating a patient

“functional level”

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4
Q

socket

A

“inferface”

what residual limb fits into

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5
Q

What is the most common reason for LE amputation?

A

dysvascular 65% followed by trauma 26%

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6
Q

The most common levels of LE amputation

A

75% transtibial

19% transfemoral

3%/3% either partial foot or other various levels

-more energy expenditure is required the higher up the amputation is

-200% increase in energy expenditure during gait with bilateral transfemoral amputee

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7
Q

K level 0

A

The patient does not have the ability or potential to ambulate or transfer safely with or without assistance and a prosthesis does not enhance their quality of life or mobility.

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8
Q

K level 1

A

The patient has the ability or potential to use a prosthesis for transfers or ambulation on level surfaces at fixed cadence. This is typical of a household ambulator or a person who only walks about in their own home.

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9
Q

K level 2

A

The patient has the ability or potential for ambulation with the ability to traverse low-level environmental barriers such as curbs, stairs or uneven surfaces. This is typical of the limited community ambulator.

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10
Q

K level 3

A

The patient has the ability or potential for ambulation with variable cadence. A person at level 3 is typically a community ambulator who also has the ability to traverse most environmental barriers and may have vocational, therapeutic or exercise activity that demands prosthetic use beyond simple locomotion.

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11
Q

K level 4

A

The patient has the ability or potential for prosthetic ambulation that exceeds basic ambulation skills, exhibiting high impact, stress or energy levels. This is typical of the prosthetic demands of the child, active adult or athlete.

-child, active adult, athlete

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12
Q

Post-operative care following amputation

A

IMMEDIATE
-healing
-compression/limb shaping
-contracture prevention
-prevent scar adhesion
-preserve or regain strength and stamina

-rigid removable dressing for contracture prevention and fall protection

SHRINKER (as long as the incision looks good)
-control edema
-phantom pain/sensation management
-compression and limb shaping

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13
Q

Immediate post-op prosthesis

A

-“rrd” - removable rigid dressing
-to be worn immediately after surgery
-allow for swelling to go down
-learn to bear weight early on

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14
Q

Amputation level LE prostheses

A

hip disarticulation
transfemoral
transtibial
transmetatarsal/partial foot

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15
Q

Types of partial foot prostheses

A

-transmetatarsal (may lose digit)

-partial foot amputation

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16
Q

Types of suspensions for LE prosthesis

A

pin lock liner or lanyard

suspension sleeve

suction

elevated vacuum

17
Q

Pin lock liner suspension facts

A

-gel liner rolled on the residual limb
-connecting pin at distal end of liner–> connects to socket
-locking mech. incorporated into socket

PROS
-simple, easy to use
-suspension seen, felt, heard (good for visual impairment)
-ease of don and doff
-liner protects skin from shear and pressure

CONS
-pistoning can occur (person’s residual limb moving up and down within socket)
-distal pulling

LEVEL
-most common at transtibial level

18
Q

Lanyard type suspension facts

A

l-gel liner rolled on the residual limb
-lanyard connected at distal end of the liner
-lanyard exit port and velcro anchor in socket

PROS
-simple, easy to maintain
-suspension seen, felt, heard (good for visual impairment)
-ease of don and doff
-pt can forcefully pull limb into socket
-liner protects skin from shear and pressure
-helps reduce rotation of residual limb in socket

CONS
-pistoning can occur
-distal pulling

LEVEL
-most common transfemoral level

19
Q

Sleeve suspension facts

A

-gel liner rolled on the residual limb
-knee sleeve extends from socket to thigh section

PROS
-simple, easy to maintain
-ease of don and doff
-liner protects skin from shear and pressure
-helps reduce rotation of residual limb in socket

CONS
-multiple layers of material restricts the knee
-pistoning can occur

LEVEL
-only used at TT level

20
Q

Suction (sealing liner) suspension facts

A

-gel liner rolled onto the residual limb
-sealing gaskets on the external surface of the liner create an air-tight seal against the interior socket wall
-one expulsion valve in the socket wall

PROS
-liner protects skin
-reduce rotation
-*reduced pistoning

CONS
-diff to don and doff (due to seal)
-diff to manage volume fluctuations

LEVEL
-used at TF and TT level

21
Q

Suction (skin fit) suspension facts

A

-pt uses a donning sleeve or pull sock to put the residual limb soft tissue into socket
-exclusive to above-the-knee amputees

PROS
-reduced rotation
-reduced pistoning

CONS
-diff to don and doff
-diff to manage volume fluctuations
-difficult fitting process

LEVEL
-only TF

22
Q

Elevated vacuum suspension facts

A

-liner rolled onto the residuum
-pump mechanism evacuates air from socket–> vacuum environment
-knee sleeve extends from socket to thigh creating airtight seal

PROS:
-most solid and secure
-solidification of soft tissues
-lack of rotation and pistoning
-encourages circulation in the limb
-reduces or eliminates volume fluctuations

CONS:
-VERY difficult to don and doff
-restriction of knee flexion due to multiple material layers (back of knee)
-more maintenance required

LEVEL:
-TT and TF

23
Q

Types of knee units LE prostheses

A

manual locking

stance brake

polycentric

hydraulic (microprocessor)

24
Q

Manual lock knee facts

A

-typical for K1
-locking mechanism engages manually or automatically upon full extension
-user must manually disengage the lock to sit (only time it will be disengaged)

PROS
-lightweight
-low cost
-certainty and security of lock mechanism

CONS
-no transition from the stance phase to the swing phase
-have to compensate with gait deviations for ambulation

SWING PHASE CONTROL:
-none
-extension assist
-constant friction

25
Q

Stance brake knees facts

A

** weight activated brake

-typical for K1-K2
-braking mechanism engages under load and disengages when unloaded

PROS
-light to moderate weight
-security of stance brake
-can adjust braking mechanism
-less effort needed for the patient to control their knee in stance (esp with limited quad strength)

CONS
-slight gait deviations needed to ambulate

SWING PHASE CONTROL
-extension assist
-constant friction–>prevent quick extension during swing
-hydraulics

26
Q

Polycentric knees facts

A

-K2-K4
-constructed of a series of linkages
-design brings the center of rotation of the knee proximal and posterior–> more stability

PROS
-inherent stability
-a smooth transition from stance to swing
-imitates normal knee –> better swing clearance
-stance flexion is possible

CONS
-must control knee in stance - glute activation

SWING PHASE CONTROL
-constant friction
-hydraulic

27
Q

Hydraulic knees facts

A

-K3-K4
-single axis or polycentric
-provides resistance in the stance phase and/or swing phase
-built to match other knee with timing of critical events of gait
-want to try to get knee centers to match on amputated vs non-amputated leg

PROS:
-good stance phase stability
-can vary resistance in stance and swing
-smooth gait
-stance flexion possible

CONS
-heavy
-increased maintenance-leaking

SWING PHASE CONTROL
-hydraulic or none

28
Q

Microprocessor hydraulic knee facts

A

-K3-K4 patients
-hydraulic unit valves are controlled by an onboard programmable processor
-microprocessor senses direction, monitors gait force at each phase of gait
-microprocessor calculates data to adjust fluid within knee

PROS
-less energy and concentration required by patient
-less buckling because this knee knows where it is in space

CONS
-increased maintenance
-leaking possible
-has to be charged
-risk of water damage
-heavy

SWING PHASE CONTROL
-hydraulic or none

29
Q

Knee unit considerations

A

-Before beginning gait training understand how the knee is controlled in swing and stance

-patients with long residual limbs may have uneven knee centers

-more features–> more weight, more complicated gait training, more maintenance

30
Q

Types of feet prostheses

A

SACH- solid ankle cushion heel

Flexible Keel

Dynamic Response

Vertical Shock

31
Q

SACH facts

A

-“solid ankle cushion heel”
-K1-2
-rigid wood or plastic core
-foam or rubber exterior
-durometer materials in heel stimulate eccentric PF

PROS
-light weight
-low maintenance
-low cost

CONS
-unresponsive
-poor compliance

32
Q

Flexible Keel facts

A

-K2-3
-composite or carbon fiber keel
-compressible heel
-simulated foot articulation, PF and DF
-flexibility level corresponds to patient weight and activity

PROS
-light weight
-low maintenance
-low cost
-smoother gait
-some are multi-axial

CONS
-minimal energy return

33
Q

Dynamic response foot facts

A

-K3-K4 patients
-series of composite or carbon fiber keels/blades/struts
-simulated foot articulation, PF and DF
-flexibility level corresponds to patient weight and activity

PROS
-very smooth gait
-multi-axial - allows 15-20 deg rotation
-energy stored and returned
-minor torque and shock absorption

CONS
-increased weight
-high cost

34
Q

Vertical shock foot facts

A

-K3-K4+ patients
-series of composite or carbon fiber keels/blades/struts
**keels designed to flex under high impact
-simulated foot articulation, PF and DF
-flexibility level corresponds to patient weight and activity
-ex: running and sprinting

PROS
-max energy return
-max torque and shock absorption
-max compliance

CONS
-max cost

35
Q

Bionic prostheses

A

-K3-K4+ patients
-electronic motors power the knee and/or ankle
-some systems can synchronize knee and ankle motion
-few patients can obtain this technology
-can to fit knees and feet that operate and communicate together

**very difficult to justify to insurance **

PROS
-replaces lost muscle function

CONS
-max cost
-bulky
-max weight
-have to charge

36
Q

How to manage volume fluctuations

A

-socks are used to manage volume changes throughout the day
-the socket must be built to accommodate this range of volume

-if don’t address volume changes, can lead to:
-skin breakdown
-pressure on bony prominences
-height discrepancy
-instability
-socket rotation
-loss of suspension

*want to avoid extra pressure on the condyles, fib head, tibia, patella

37
Q

What is a common prosthetic or patient cause of uneven step length or uneven step timing?

A

pain caused by socket

pain caused by OA

38
Q

What is often the single greatest limitation to normalized gait in patients with above-the-knee prostheses?

A

fear or anxiety of falling

MVMT SCI II (9 decks)

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