LE PROSTHETICS Flashcards
(38 cards)
Alignment
looking at whole relationship between all componentry, socket, patient anatomy to get most optimal gait possible
Pylon
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.
K-level
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”
socket
“inferface”
what residual limb fits into
What is the most common reason for LE amputation?
dysvascular 65% followed by trauma 26%
The most common levels of LE amputation
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
K level 0
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.
K level 1
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.
K level 2
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.
K level 3
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.
K level 4
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
Post-operative care following amputation
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
Immediate post-op prosthesis
-“rrd” - removable rigid dressing
-to be worn immediately after surgery
-allow for swelling to go down
-learn to bear weight early on
Amputation level LE prostheses
hip disarticulation
transfemoral
transtibial
transmetatarsal/partial foot
Types of partial foot prostheses
-transmetatarsal (may lose digit)
-partial foot amputation
Types of suspensions for LE prosthesis
pin lock liner or lanyard
suspension sleeve
suction
elevated vacuum
Pin lock liner suspension facts
-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
Lanyard type suspension facts
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
Sleeve suspension facts
-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
Suction (sealing liner) suspension facts
-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
Suction (skin fit) suspension facts
-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
Elevated vacuum suspension facts
-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
Types of knee units LE prostheses
manual locking
stance brake
polycentric
hydraulic (microprocessor)
Manual lock knee facts
-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
